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Bulk Sample Data and Chain of Custody, P.S. 89M

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Chain of custody form and data sheet for bulk asbestos samples collected at P.S. 89M on Warren Street during AHERA reinspection.

NYC-WTC_000178587–000178590
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NYC 9/11 Public Portal Document

Page 3 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 York,NY10282 4a. lnvesligator:Mark Nakhumovich

5. Date: 6. Building Name; P.S.89M SJTumaround Time: 9. Comments (Field); □ STAT □ □ 72 HRS Q 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 P.S.89M-5/24/02- Fiberglass- LI Settled Dust P.S.89M-5/24/02- Fiberglass- 2.2, Settled Dust P.S.89M-5/24/02-

23 Fiberglass- 2. Settled Dust P.S.89M-5/24/02- 2^ Fiberglass- i y Settled Dust P.S.89M-5/24/02- 2r Fiberglass- Settled Dust P.S.89M-5/24/02- 26 Fiberglass- T,C Settled Dust P.S.89M-5/24/02- 27 Fiberglass- 4 7 Settled Dust P.S.89M-5/24/02- ;?376 72 Fiberglass- © Settled Dust P.S.89M-5/24/02- 7^ Fiberglass- Settled Dust

3o P.S.89M-5/24/02- 7 Fiberglass- Settled Dust CHAIN OF CUSTODY 17. Relinquished By; 18. Date: 19. Time: 20. Received By; 21. Date: 22. Time; 23. Method of Submittal:

zz FIELD WALK IN US MAIL FED-X OTHER

LAB INFORMATION 24. Name and Signature: 25. Date: 26. Time; 27. Comments (Lab): 24a. Analyzed By: iiVicuty I 'u 24b- Analyzed By: Y QC By:

Filename: P:1USERS\DATA\WP96\WP\FORMS\.NY-13,XLS Form NY-13

CONFIDENTIAL . CITY_21MC100_001902508 SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008 NYC-WTC_000178589

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NYC-WTC_000178589Source: NYC Law Department, mirrored locally

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