NYC 9/11 Public Portal Document
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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 Efstatliiou
37Date: 6. Building Name:PS 89M 8. Turnaround Time: 9. Comments (Field):
□ STAT □ 24 HRS □ 72 HRS Q OTHER Analyzed all them for fiberglass
7. Sampling Areas: 10. Time in / Time out:
All4ftA □ 6 HRS Q 48 HOURS □ NORMAL
SAMPLE ID MATERIAL LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
PS89M-2/14/G2-
Fiberglass-^/ Settled Dust _____________
PSS9M-2/14/02-
Fiberglass-^^ Settled Dust
PS89M-2/14/02-
Fiberglass-^j^ Settled Dust
PS89M-2/14/02-
Fiberglass- Settled Dust
PS89M-2/14/02-
Fiberglass-^^ Settled Dust 4°/l> ^67.
PS89M-2/14/G2-
Fiberglass- Settled Dust A/i)
PS89M-2/14/02-
Fiberglass- ^22. Settled Dust vr>
PS89M-2/14/C2-
Fiberglass- Settled Dust J
PS89M-2/14/02-
Flberglass-^^ Settled Dust V f>
PS89M-2/14/02-
Fiberglass-
==S===S=:SSS3SSSSSS=S=3=B=^S
Settled Dust S3SSSSS
CHAIN OF CUSTODY
17. Relinquished By; 18. Date: 19. Time; 20. Received By: 21. Date: 22. Time: 23. Method of
Submittal:
FIELD
WALK IN
US MAIL
/
FED-X
OTHER
LAB INFORMATION
24. Name and Signature; 25. Date: 26. Time: 27. Commenis (Lab);
24a. Analyzed By;
24b. Analyzed By:
j o fC
24c. QC By:
FilHuuiK P:lUSEItSWATAiWP96\WPiFORMSlNY-13.XLS Fam NY-13
CITY_21MC100_002880516
NYC-WTC_000219438
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