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General Field Verification Form, PS 89 M, undated
Machine-extracted title · confidence 96%Form verifying on-site asbestos technician and air sampling services performed by ATC Associates Inc. at a New York City Board of Education school.
NYC-WTC_000185959Page image
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NYC 9/11 Public Portal Document
I NEW YORK CITY BOARD OF EDUCATION GENERAL FIELD VERIFICATION FORM
NAME OF THE CONSULTIEiG FIRM: ATC Associates Inc. SPECIFICATION NO.:
SCHOOL: ADDRESS: <^0/, 6T , Piy 102^2.
TYPE OF SERVICES PROVIDED: (check as applicable) 1 □ ASBESTOS TECHNICIAN □ PROJECT DESIGNER* □wise. CONSULTING SERVICES AIR SAMPLING TECHNICIAN □ PROJECT MONITOR
LOCATIONS(S): EnJ-irt. , (-^c/______ WORK PERFORMED:
DATE TIME NAME OF THE NAME & SIGNATURE IN OUT PROFESSIONAL ; OF AUTHORIZED PERSONNEL CUSTODIAN/PRINCIPAL name (print) signature name (print) signature ©© 7 00 .bh/o2 1 7°M I i
J
Q
K klOTE: Please complete the following as applicable, indicate "N/A" if not applicable. I '! I—i Asbestos Inspector's no. of school visits: s o Air Sampling Technician's no. of school visits^ o o Io ‘Minimum payment for Project Designer's services shall be four (4) times the unit price per hour. o Project Monitor's total no. of hours: co I—i o co co Mise, consulting services no. of hours: LO LO
NYC-WTC_000185959
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NYC-WTC_000185959Source: NYC Law Department, mirrored locally
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