NYC-WTC_000199124

NYC 9/11 Public Portal Document “S'" VI

ATC ASSOCIATES INC. BATCH NO. 1(I BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM PROJECT INFORMATION 1. Client: NYC-BOE 2. Project Nam .A.HERA RE INSPECTION J, Project # 145S4-OS23 4, Project Manager:Yianiiis Eistatliiou

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

5. Date: 6. Building Name:PS234M 8. Turnaround Time: 9. Comments (Field): □ STAT 0 24 HRS Q 72 HRS □ OTHER Anaiyze4ail of them for fiberglass 7. Sampling Areas: 10. Time in / Time out: □ 6.HRS 048 HOURS □ NORMAL V- SAMPLE ID .MATERIAL LOC.ATION FLOOR RESLLTS H.A.# NUMBER DESCRIPTION .NUMBER PS234M-3/3cTT' St.,, 3 Fiberglass- 11 Settled Dust PS234M-3/5%’or o. Fiberglass- 11_ Settled Dust V \ sa C. V I PS234M-33e/02- Ia.'-I *<N Vn Ca V i Fiberglass- I 3 Settled Dust N V

PS234M-3/y*/02- "i-aovv-. T T■ XvX

Fiberglass- lUj- Settled Dust PS234M-3/J--.02- '5 Fiberglass- 15 Settled Dust C\c,s^ A-oos ).'13 f loo Y 2- PS234M-3/i‘’/02- (U Fiberglass- Settled Dust L zAza PS234M-3/3-’,u2- n Fiberglass- H Settled Dust C\c.SS 7-11 T /VZ) PS234M-3/3^/02- 1-^ 2. st 7- Fiberglass- Settled Dust PS234M-3/3'*yd2- C_ \ ■. A S 0- vi. S'- -3 >• Fiberglass- ' “i Settled Dust PS234.\I-3/3‘j^ Lo 7,017. Fiberglass- 2-^ Settled Dust CHAIN OF CUSTODY 17. Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. Time: 23. Method of Submittal: FIELD 1 i u 3^ / ' / (Ic^ WALK IN LIS mail FED-X OTHER

LAB information 24. Name and Signature: 25. Date:: 26. Time: 27. Comments (Lab): 24a. .Analyzed By: 24b. Analyzed 3v: 24c. QC By:

Filename: P ■USERS\DATA\WP<)6\WP'FOR.\IS\NY-13 XLS Form SY-1?

CITY_21MC100_003031546

NYC-WTC_000199125