NYC 9/11 Public Portal Document
Page of
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# 14584-0819 4. Project Manager: ANDREAS ANDREOU
2a. Project Address:201 Warren street, New York, NY 10282 4a. Investigator:Yiannis Efstathiou
5. Date: 6. Building Name.PS 89M 8. Turnaround Time: 9. Comments (Field):
Q STAT □ 24 HRS □ 72 HRS □ OTHER Analyzed all them for fiberglass
7. Sampling Areas: 10. Time in / Time out:
EJbHRS 048 HOURS Q NORMAL
> I ' SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# i NUMBER DESCRIPTION NUMBER
PS89M-1/25/02-
Fiberglass- 0 / Settled Dust
PS89M-I/25/02- tj2» /T€(s»-Q 0'2
Fiberglass- Settled Dust
PS89M-1/25/02-
Fiberglass- Settled Dust
PS89M-1/25/02-
Fiberglass-
PS89M-I/25/02-
Settled Dust ____________________________________ /\/D
Fiberglass- OS' Settled Dust _____________(S^ s/c/e nd
1
CHAIN OF CUSTODY
17. Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. Time: 23. Method of
Submittal:
FIELD
c
WALK IN
US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signafaye: 25. Date: 26. Time: 27. Comments (Lab):
Analyzed By:/
24a.
24b. Analyzed By: /
24c. QC By:
Filename: P:\tJSERS\DATA\WP96\WP\FORMS\NY-13.XLS Form NY-13
CITY_21MC100_003030836
NYC-WTC_000198914
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