Asbestos field verification form, PS 25LH, Oct 2001

NYC 9/11 Public Portal Document

NEW YORK CITY BOARD OF EDUCATION GENERAL FIELD VERIFICATION FORM

NAME OF THE CONSULTING FIRM: ATC Associates Inc. SPECIFICATION

SCHOOL: _ 25LH______ ADDRESS;

TYPE OF SERVICES PROVIDED: (check as applicable)

□ ASBESTOS TECHNICIAN □ PROJECT DESIGNER* Wise. CONSULTING SERVICES □ AIR SAMPLING TECHNICIAN D PROJECT MONITOR

LOCATIONS(S)^^/^^^XY*-^^ WORK PERFORMED: dLiuiil iurtfeter Testing

DATS - - TIME , NAME OF THE NAME & SIGNATURE 'N ... .h PROFESSIONAL ■ , OF AUTHORIZED PERSONNEL i ■ CUSTODIAN/PRINCIPAL - 84 name (print) signature narhe (print) signature

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I NOTE: Please complete the following a.s applicable, indicate "N./.A" if not applicable. to

s O Asbestos Inspector’s no. of school visits: o Air Sampling Technician's no. of school visits: o I o ‘Miniinum.payment for Project Designer's services shall be four (4) times the unit price per hour. o Pioject Monitor's total no. of hours:

CO Mise, consulting services no. of hours:

NYC-WTC_000185966