NYC-WTC_000207753

NYC 9/11 Public Portal Document

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ASSOCIATES INC. BATCH NO.

BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM PROJECT INFORMATION 1. Client: NYC - pOE 2.Project Name; PS 42M 3. Project# 14584-0871 4. Project Manager:Yiannis Efstathiou

2a. Project Address: 71 Hester Street, New York.NY 10002 4a. Investigator: Mark Nakhumovicb

5. Date: 6. Building Name: P.S. 42M ii. Turnaround Time: 9. Comments (Field): □ STAT □ □ 72 HRS □ OTHER Analyzed all of them for fiberglass 7. Sampling Areas; 10. Time in / Time out: 1 z c-i □ 6 HRS 048 HOURS □ NORMAL SAMPLE ID MATERIAL LOCATION FLOOR RESULTS H.A.# NUMBER DESCRIPTION NUMBER P.S. 42M-9/3/02- .-Is/- ^Jcc>r lohb^ I Fiberglass- i Settled Dust P.S. 42M-9/3/02- kJ z 2. Fiberglass- 2- Settled Dust zjLd P.S. 42M-9/3/02- /Atidik'I Cc nd Settled Dust AJh Xz Fiberglass- 3 P.S. 42M-9/3/02- Fiberglass- Settled Dust CLd ! A U/. r P.S. 42M-9/3/02. Fiberglass- 3” Settled Dust P.S. 42M-9/3/02- Q Fiberglass- Settled Dust A)b P.S. 42M-9/3/02- J Fiberglass- Settled Dust _________________________ P.S. 42M-9/3/02- 8 Fiberglass- Settled Dust LoWi P.S. 42M-9/3/02- 9 4 //t -V Fiberglass- Q Settled Dust Aih P.S. 42M-9/3/02- Ik) Fiberglass- Settled Dust ssss 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 ®L/kXi WALK IN US MAIL FED-X OTHER

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

Filmame: P \USERS\DATA\WP9S\WP\FOIIMS\NY- I3.XLS Form NY-13

CITY_21MC100_003015839

NYC-WTC_000207753