NYC 9/11 Public Portal Document
Page 3 of
•ATC ASSOCIATES INC. BATCH NO.
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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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