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# 14584-0864 4. Project Manager:Yiannis Efstathiou
2a. Project Address:90 Trinity Place, New York,NY10006 4a. Investigator: Yiannis Efstathiou
5. Date: 6. Build ng Name:M894 8. Turnaround Time: 9. Comments (Field):
□ STAT O □ 72 HRS □ OTHER Analyzed all of them for fiberglass
3 ’Mo; 7. Sampling Areas;
□ 6 HRS 048 HOURS □ NORMAL
10. Time in / Time out:
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
M894-5/2/02-
Fiberglass-^ f Settled Dust
M894-5/2/02-
Fiberglass- Q9
M894-5/2/02-
Settled Dust /a
Fiberglass- Q;?
M894-5/2/02-
Settled Dust
Mu
Fiberglass- q cL
M894-5/2/02-
Fiberglass- 0$^
Settled Dust
Settled Dust
MU-
M894-5/2/02-
Fiberglass- Settled Dust AM
M894-5/2/02-
Fiberglass-^j£ Settled Dust
M894-5/2/02-
Fiberglass-^^ Settled Dust
MU /d4
M894-5/2/02- V /
Fiberglass- O y Settled Dust
M894-5/2/02-
Fiberglass- Settled Dust
. . s=s=ssssss
x,<i6
CHAIN OF CUSTODY
17. Relinquished By; 18. Date: 19. Time: 20. Received By: 21. Date: 22. Time: 23. Method of
Submittal:
ci
FIELD
WALK IN
US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signature: 25. Date: 26. Time: 27. Comments (Lab);
24a. Analyzed By: /o /ZZY
24b. Analyzed By:
24c. <JC By:
Hlmanie: P \USER.S'DATA\WP96\WP\FORMS\NY-13 XLS Fumi NY-13
CONFIDENTIAL, CITY_21MC100_003390710
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000178802
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