NYC 9/11 Public Portal Document
Page of
ATC ASSOCIATES INC. BATCH NO.
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
1. Client; NYC - BOE 2. Project Nam AHERA REINSPECTION 3. Project# 14584-0819 4. Project Manager:Yiannis Efstathiou
2a. Project Address:201 Warren street. New Yorfc,NY10282 4a. Investigator:Yiannis Efstathiou
5. Date: 6. Build ng Name:P.S.89M 8. Turnaround Time: 9. Comments (Field):
Q STAT □ 24 HRS □ 72 HRS Q OTHER Analyzed all of them for fiberglass
7. Sampling Areas: 10. Time in / Time out:
□ 6 HRS □ 48 HOURS □ NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
PS89M-4/5/02-
Fiberglass-^7 Settled Dust
PS89M-4/5/02-
Fiberglass-^^ Settled Dust lce> rl
PS89M-4/5/02-
Fiberglass-;^^ Settled Dust
PS89M-4/5/02-
Fiberglass-^^ Settled Dust /VZ)
PS89M-4/5/02-
///
Fiberglass- ^5 Settled Dust
PS89M-4/5/02-
Fiberglass-
PS89M-4/5/02-
Settled Dust ___ /UI
Fiberglass-^^ Settled Dust
_
PS89M-4/5/02-
Fiberglass-,Z<Y Settled Dust /Gk)
PS89M^/5/02-
Fiberglass-
PS89M-4/S/02-
Settled Dust /UI
Fiberglass- 30 Settled Dust :^30l J,
CHAIN OF CUSTODY
L_=__= U /
17. Relinquished By: 18. Date: 19. Time; 20. Received By: 21. Date: 22. Time;""'.. 23. Method of
Submittal:
FIELD
4( s-( ■ L WALK IN
US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signature: 25. Date: 26. Time: 27. Comments (Lab):
24a. Analyzed By: / Vl A /A 2
24b. Analyzed By:
24c. QC By:
Filename P:\USERS\DATA\Wpq6\WP\FORMS\NY-I3 XLS Form NY-13
CONFIDENTIAL, CITY_21MC100_003473774
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000177691
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