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 Adtiress:201 Warren street. New York,NY10282 4a. lnvestigator:Mark Nakiiumovich
5. bate: 6. Building Name: P.S.89M 8. Turnaround Time: 9. Comments (Field):
□ stat □ □ 72 HRS □ OTHER Analyzed all of them for fiberglass
T-SV-Oit 7. Sampling Areas; □ 6 HRS □ 48 HOURS □ NORMAL
10. Time in / Time out:
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
P.S.89M-5/24/02-
if Fiberglass- 5( Settled Dust
P.S.89M-5/24/02-
Fiberglass- 32 Settled Dust
P.S.89M-5/24/02-
S3 Fiberglass- 33 Settled Dust
P.S.89M-5/24/02-
Fiberglass- Settled Dust
P.S.89M-5/24/02-
if Fiberglass- 3 Settled Dust
P.S.89M-5/24/02-
R S^iZ
Fiberglass- 5(> Settled Dust
P.S.89M-5/24/02-
ToG
Fiberglass- J 7 Settled Dust
P.S.89M-5/24/02-
Fiberglass- Settled Dust
P.S.89M-5/24/02-
JI Fiberglass- 3,9 Settled Dust
P.S.89M-5/24/02-
^0
5 32.
Fiberglass- O Settled Dust
CHAIN OF CUSTODY
17. Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. Time: 23. Method of
/ Submittal:
y-iy /z FIELD
us MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signature: 25. Date: 26. Time: 27. Comments (Lab):
24a. Analyzed By:
24b. Analyzed By:
24c. QC By:
Filename; P;\USERS\DATA\WP96\WP\FORMS\NY-13.XLS Form NY-13
CONFIDENTIAL, CITY_21MC100_001902509
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000178590
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