NYC 9/11 Public Portal Document
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Page of
ATC ASSOCIATES INC. BATCH NO.
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
I Client NYC - ©OE 2 Project Name PS 42M 3 Project# 14584-0871 4 Project Manager Yiannis Efsuthiou
'2a Project Address 71 Hester Street, New York,NY 10002 4a Investigator Mark Nakhumovich
15 Date 6 Building Name. P S 42M s Turnaround Time 9. Comments (Field):
□ stat □ □ 72 HRS □ OTHER Analyzed all of them for fiberglass
7 Sampling Areas 10 Time in / Time out
□ 6 HRS □48 HOURS □ NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
P.S. 42M-9/3/02- J-sA ^-(cor
Fiberglass- ( Settled Dust
aJ7
P.S. 42M-9/3/02-
Fiberglass- '2, Settled Dust
P.S. 42M-9/3/02-
/^cedi-k'nctw XU
Fiberglass- 3 Settled Dust
P.S. 42M-9/3/02-
Fiberglass- Settled Dust
O rfiPrA -/A .^<0 (1
"T
zcfor /
P.S. 42M-9/3/02-
Fiberglass- Settled Dust
(5
P.S. 42M-9/3/02-
Q Fiberglass- Settled Dust
P.S. 42M-9/3/02-
■)
Fiberglass- 7 Settled Dust
P.S. 42M-9/3/02-
8 Fiberglass- Settled Dust ZZ .
P.S. 42M-9/3/02-
Fiberglass- Q Settled Dust
P.S. 42M-9/3/02-
to Fiberglass- Settled Dust
CHAIN OF CUSTODY Please call Project Manager 646-772-1155
17 Relinquished By 18 Date 19 Time 20 Received By 21 Date 22 Time 23 Method of
Submittal
FIELD
walk IN
US MAIL
FED-X
OTHER
LAB INFORMATION
24 Name and Signature- 25 Date 26 Time- 27 Comments (Lab).
24a Analyzed By /H. /D ZY
24b. Analyzed By
24c QC By
Filename P MJSERS\DATA\WP96\WP1FORMS\NY.13 XLS FomiNY-D
CITY_21MC1OO_OO3O42867
NYC-WTC_000196765
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