NYC 9/11 Public Portal Document
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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 York.NY 10282 4a. Investigator:Yiannis Efstathiou
5. Date: 6. Building Name:P.S.89M 8. Turnaround Time: 9. Comments (Field):
□ STAT □ 24 HRS □ 72 HRS □ OTHER Analyzed all of them for fiberglass
7. Sampling Areas. 10. Time in / Time out:
□ 6 HRS 048 HOURS □ NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
PS89M-4/5/02-
Fiberglass-^ j Settled Dust
PS89M-4/5/02-
Fiberglass- ^2, Settled Dust
PS89M-4/5/02-
Fiberglass- .^ 3^ Settled Dust
PS89M-4/5/02-
Fiberglass-
PS89M-4/5/02-
Settled Dust /1
Fiberglass- Settled Dust
PS89M-4/5/W-
Fiberglass-^^^
PS89M-4/5/02-
Settled Dust zK
Fiberglass- Settled Dust
PS89M-4/5/02-
Fiberglass-T?^ Settled Dust
PS89M-4/5/02-
Fiberglass-39 Settled Dust
PS89M-4/5/02-
Fiberglass- Settled Dust
CHAIN OF CUSTODY
17. Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. 23. Method of
Submittal:
FIELD
ra r Ca
vp© / WALK IN
US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signature: 25. Date: 26. Time: 27. Comments (Lab):
24a. Analyzed By:
24b. Analyzed By: Wy
24c. QC By:
Filename P:\USERS\DATAtWP96\WP\FORMS\NY-13.XLS Form NY-13
CONFIDENTIAL, CITY_21MC100_003473775
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000177692
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