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
I. Cl ent; NYC - BOE 2. Pro.ectNam AHERA REINSPECTION 3. Project# 14584-0824 i. Project ManagerYiannis Efstathiou
2a. Project Address:334 Greenwich street. New York, NY' 10013 4a. Investigator;
L/I 1> 4
5. Date: 6. Building Narne;P.S.150M 8. Tui-naround rime: 9. Comments (Field);
7, Sampling Areas:
Q STAT □ 24 HRS □ 72 HRS M OTHER Analyzed all them for tiherglass
10. Time in / Time out:
3’ /f-02. □ 6 HRS □ 48 HOURS □normal
SAMPLE ID MATERIAI, LOCATION FLOOR RESULTS
H.A.# NUMBER DESCRIPTION NUMBER
'P!S150M-3/902
Fiberglass-Q j Settled Dust
P.S150M-3/902
Fiberglass- Settled Dust
P!hl50M-3/902
Fiberglass-^7 Settled Dust
PS150M-3/902
S-Qi,
Fiberglass-^/y Settled Dust
CHAIN OF CUSTODY
17, Relinquished By: 18. Date: 19. Time: 20. Received By: 21. Date: 22. Time: 23. Method of
Submittal:
7 FIELD
7 7 S’ff'C'Z a/11(6 2 WALK IN
F US MAIL
FED-X
OTHER
LAB INFORMATION
24. Name and Sianatuie: 25. Dale: 26. Time: 27. Comments (Lab):
24a. Analyzed Bv: YviJt--, L! -zh/o', , I 6
24b. .Analyzed Bv; T”
24c. QC By
Fiknaiw P ’USERS'YOATA.WKe>\WPTORMS\NY-13.XLS Fonn NY-13
CONFIDENTIAL, CITY_21MC100_011528514
SUBJECT TO PROTECTIVE ORDER NO. 2, SEPT. 2008
NYC-WTC_000229929
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