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NYC-WTC_000178626

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NYC 9/11 Public Portal Document

Page / of L ATC ASSOCIATES INC. BATCH NO* ________ lIlCAZlE BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM PROJECT INFORMATION I. Client: NYC-BOE 2 ProjeciNam AHERA RHNSPECTION 3 Project* 19125-0246 4 Project Manager

2a Project Address.345 Chambers Street, New \ ork, NY 10007 4a. investigator Herant .Antonyan

i Date; 6 Building Name;Stuyvesani & Turnaround Time: 9. Tomineuis (Field): ___ ___________ HS fM477) 0 STAT □ 24 HRS □ 72 HRS Ifa OTHER Analyzed alt them foi fiberglass 7. Samplmg Areas Entire 10 Time in Time out 06HR1S 048 HOURS 0 NCy<MAL

SAMPLE ID material LOCATION FLOOR RESULTS H.AJI NUMBER DESCRIPTION NliMBER M477 - / Fiberglass Bulk - Settled Dust M477 - Fiberglass Bulk - Settled Dust 3 M477 - “

3 Fiberglass Bulk - Settled Dust /-Z4ZZZ7 aJa M477.

Fiberglass Bulk - Settled Dust -^s y M477 - Fiberglass Bulk - Settled Dust //i M477- 7^-/^

Fiberglass Bulk - Settled Dust 7/ M477 - Fiberglass Bulk - Settled Dust M477- ^3^ zlZ 3 Fiberglass Bulk - M477 - Settled Dust '<JA 5 Fiberglass Bulk - Settled Dust M477- Fiberglass Bulk - Settled Dust CHAIN OF Cl]STODY/%<,s« y'ex//^4uz,4^€Z f^Tz/X Z<.sdzz^3 77.2-//5'3' 17. Relinquished By: 18. Dale:; 19. Time; 20. Received By: |2'l. Dale: * 22. Time: 23. Method of Submirta!' FIELD WALK IN US MAIL FED-.X OTHER

LAB INFORMATION -4. Name and Signature: 25 Date: 26 Time 27. Commcnis (LabF

24a. Analyzed By: V^t^AodACf,/ (O 24E Anal)2edE^ 24c. QC By;

Filename P;MJSERS'.DATA'*'PWiWF'.FOIlMSiNY.|3..'<LS Foitd NV* IJ

CONFIDENTIAL, CITY_21MC100_003390166 SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008

NYC-WTC_000178626

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NYC-WTC_000178626Source: NYC Law Department, mirrored locally

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