NYC-WTC_000199147

NYC 9/11 Public Portal Document

Page 3 of ATC ASSOCIATES INC. BATCH NO.

BLILK SAMPLE DATA AND CHAIN OF CUSTODY FORM PROJECT information 1. Client: NYC - BOE 2. Project Nam AHERA REINSPECTION 3. Project# 14584-0823 4. Project Manager. Yiannis Efstathiou

2a. Project Address:292 Greenwich street. New York,NY10007 4a. InvestigatoriChacko Mathew

5. Date: 6. Building Name: P.S.234M 8. Turnaround Time; 9. Comments (Field): □ stat □ □ 72 HRS Q 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.234M-5/aS;/02- f\O4. ✓ 0.0 Fiberglass- X' Settled Dust □- P.S.234M-5/:^02- Fiberglass- XX Settled Dust -r 'p.S.234M-5/I$/02- 3^ 'Huons ^3 Fiberglass- XS Settled Dust X P.S.234M-5/aJ/02- XI *6 Fiberglass- X«+ Settled Dust P.S.234M-5/a>/02- xs Fiberglass- Settled Dust C.\«.SS X-X I

P.S.234M-5M/02- xt Fiberglass- Xt Settled Dust laSi-WK T-T-S

P.S.234M-5/a£/02- XI Fiberglass- X"} Settled Dust P.S.234M-5/iK/02- x% Fiberglass- XSs Settled Dust P.S.234M-5Zi£/02- c_\*ss rrj ■axs Fiberglass- Settled Dust P.S.234M-5/J^/02- C-Vcis noo-so Fiberglass- S® Settled Dust CHAIN OF CUSTODY 17. Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. Time: 23. Method of Submittal: FIELD ■rkfVix- WALK IN US MAIL FED-X OTHER

LAB INFORMATION 24. Name and Signature: 25. Date: 26. Time: 27. Comments (Lab): 24a. Analyzed By: CaVxX. Cjl/ 24b. Analyzed By: 24c. QC By;

Filename; PAUS ERS\DATA\WP96\ WP\FORMS\NY-13 XLS FonnNY.13

CITY_21MC100_003031713

NYC-WTC_000199149