NYC-WTC_000229633

NYC 9/11 Public Portal Document

Page / of L ATC ASSOCIATES INC. BATCH NO.

BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM PROJECT INFORMATION 1, Client: NYC - pOE 2.Projecl Name: PS 42M 3. Project# 14584-0871 4. Project ManagcriYiannis Efstalhiou

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

5. Date: 6, Build ng Name: P.S. 42M S. Turnaround Time. 9. Comments (Field); □ stat □ □ 72 HRS Q OTHER Analyzed all of them for fiberglass

c-a. 7. Sampling Areas: QbHRS 048 HOURS □NORMAL 10, Time in / Time out;

SAMPLE ID MATERIAL LOCATION FLOOR RESULTS

H.AJ NUMBER DESCRIPTION NUMBER

P.S. 42M-9/3/02- I Fiberglass- f Settled Dust P.S. 42M-9/3/02- Fiberglass- Z Settled Dust P.S. 42M-9/3/02- kij 7” /Aadife'Cfcti'n Fiberglass- 3 Settled Dust P.S. 42M.9/3/02- Fiberglass- Settled Dust r UA r P.S. 42M-9/3/02- Fiberglass- P.S. 42M-9/3/02- Settled Dust

c Fiberglass- P.S. 42M.9/3/02- Settled Dust /UA AJL ■)

Fiberglass- Settled Dust P.S. 42M-9/3/02- 3 Fiberglass- Settled Dust t67r7</ A/: P.S. 42.M-9/3/02- 9 Fiberglass- Cf Settled Dust AJ-h P.S. 42M-9/3/02- /o Fiberglass- Settled Dust ■S’- //A CHAIN OF CUSTODY P ease 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 WALK IN US MAIL FED-X OTHER

LAB INFORMATION 24. Name and Signature; 25. Date; 26. Time: 27. Comments (Lab):

24a. Analyzed By; /K A' 24b. Analyzed By: 24c. QC By:

Filename: P-\USERSU)ATA\WmWP\FORMS\NY.n.XU Fonn NY-13

CONFIDENTIAL, CITY_21MC100_003414412 SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008

NYC-WTC_000229633