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 RErNSPECTION 3. Project# 14584-0819 4. Project ManagerYiannis Efstathiou
2a. Project Address:201 Wanen street, New York,NY10282 4a. Investigator-.Mark Nakhumovich
5. Date: 6. Building Name: P.S.89M 8. Turnaround Time: 9. Comments (Field):
□ stat O □ 72 HRS □ 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
P.S.89M-5/24/02-
//
Fiberglass- // Settled Dust
P.S.89M-5/24/02-
Fiberglass- /'2 Settled Dust
P.S.89M-5/24/02-
fl Fiberglass- fi, Settled Dust
P.S.89M-5/24/02- fi- soy
Fiberglass- Settled Dust
P.S.89M-5/24/02-
Fiberglass- Settled Dust
P.S.89M-5/24/02-
/6 Fiberglass- // Settled Dust
P.S.89M-5/24/02-
/7 Fiberglass- Settled Dust
P.S.89M-5/24/02-
Fiberglass- Settled Dust
P.S.89M-5/24/02-
>1 Fiberglass- Settled Dust
P.S.89M-5/24/02-
Fiberglass- 'I J Settled Dust
CHAIN OF CUSTODY
17. Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. Time: 23. Method of
Submittal:
FIELD
WALK IN
7 f '
US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signatuje: 25. Date: 26. Time: 27. Comments (Lab):
24a. Analyzed By: \ C (Pl uQ.
24b. Analyzed By:
24c. QC By:
Filename: P:\USERS\DATA\WP96\WP\FOW'4S\NY.13.XLS Form NY-13
CONFIDENTIAL, CITY_2IMCl00_001902507
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000178588
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