NYC-WTC_000196541

NYC 9/11 Public Portal Document

Page of H- ATC ASSOCIATES INC. BATCH NO. —_______________■

BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM PROJECT INFORMATION 1. Client: NYC - BOE 2. Project Nam AHERA R.EINSPECTION 3 Project# 14584-0823 4. Project Manager:Yiannis Efstathiou

2a. Project Address:292 Greenwich street, New York, NY 10007 4a. InvestigatorChacko Mathew

5. Date: 6. Built mgName:P.S.234M 8. Tumaround Time: 9. CommenW (Field): 0 STAT 0 24 HRS 0 72 HRS 0 OTHER Analyzed all them for fiberglass 7. Sampling Areas 10. Time in / Time out: 0 6 HRS 048 HOURS 0 NORMAL

SAMPLE ID MATERIAL LOCATION FLOOR RESULTS H.A.# NUMBER DESCRIPTION NUMBER PS234M-3/902

o' Fiberglass- C I Settled Dust S - PS234M-3/902 UTii-.’p.X

or Fiberglass- C>X Settled Dust t, I Y'a « 4 PS234M-3/902 ^"0?' \ ' J Fiberglass- 02 Settled Dust e.«xsv S.A- PS234M-3/902 A tYcv, "E-vy VsVI t, A CA Fiberglass- qIj- Settled Dust Cvi V t. N e T Ci-fvA w V'- *!> < v.K Cl 1' H V,

PS234M-3/902 OS Fiberglass- Settled Dust QC^.<ve Vc tic ) PS234M-3/902 Ot Fiberglass- C’^ Settled Dust I*;,

PS234M-3/902 t-oTsv VA, ol Fiberglass- o'] Settled Dust PS234M-3/902 O'S Fiberglass- 0 Settled Dust Cu X 5 U vt X 4 << V e_ 1 A t. e

PS234M-3/902 WC e_ V C—J C.| OU, VI A yq J, YX. X \ a e- I Fiberglass- ori Settled Dust PS234M-3/902 s, X K C A to Fiberglass- Jc Settled Dust CT X CHAIN OF CUSTODY 17. Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. Time: 23. Method of Submittal:

n g-lC 'h { sWov- /" f FIELD WALK IN 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.XtS FnitnNY-lt CITY_21MC100_003057619

NYC-WTC_000196541