NYC 9/11 Public Portal Document
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ATC ASSOCIATES INC. BATCH NO.
^OOGQ
BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM
PROJECT INFORMATION
I. Client: NYC - BOE 2. Project Nam AHERA REINSPECTION 3. Project# 14584-084y- 4. Project Manager: ANDREAS ANDREOU
2a. Project Address:'^’^ York, NY \QOC>(^ 4a. lnvestigator;Yiaiinis Efstatliiou
5. Date: 6. Building Name:_.<^^^ 8. Turnaround Time: 9. Comments (Field);
Q STAT Q 24 HRS Q 72 HRS □ OTHER Analyzed all them for fiberglass
'^sj^ 7. Sampling Areas:
□ 6 HRS 048 HOURS □NORMAL
10. Time in / Time out:
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
M894-2/8/02-
Fiberglass-^ Settled Dust
M894-2/8/02-
Fibcrglass-^;2- Settled Dust
M894-2/8/02-
Fiberglass- 2^ Settled Dust 5515:^2
M894-2/8/02- 7
Fiberglass- Settled Dust
M894-2/8/02-
Fiberglass-’^25^ Settled Dust
M894-2/8/02-
Fiberglass-^^ Settled Dust
M894-2/8/02-
Fiberglass- Settled Dust
M894-2/8/02-
Fiberglass- Settled Dust
M894-2/8/02- 5fd plctrr
Fiberglass- Settled Dust
. CHAIN OF CUSTODY
17. Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. Time: 23. Method of
Submittal:
FIELD
WALK IN
/7 US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Signature; 25. Date: 26. Time: 27. Comments (Lab):
24a. Analyzed By:
24b. Analyzed By;
24c. QC By:
Filename: P:\USERS\DATA\WP96\WP\FORMS\NY-13.XLS Form NY.13
CITY_21MC100^002854317
NYC-WTC_000215142
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