NYC-WTC_000232328

NYC 9/11 Public Portal Document

e Page of ) BATCH NO. __

'97 7,3 PROJECT INFORMATION BULK SAMPLE DATA AND CHAIN OF CUSTODY FORM 1. Client; 2, Pioiec! Name; 3. Pioject No: 4. P-ciact Manager:

2a. Proiect Address: ' T -vCO. 4a. Irivestigator; ;5. Date; 6 Building Name: 8. Turnaround Time; 9. Comments (Field) Y'Y, I ' Sampling Areas: □ STAT □ 24 HRS □ ;2 HRS □ OTHER ill □ 6 HRS □ 48 HRS □ NORMAL L2^ BULK SAMPLE LOCATION I 10, 11. 12. 13. 14. 15. 16. Sample Location Material Material Asbestos Homogenous Bulk Sample Thermal Total Quantity Content Area No. ID No System Floor Sample Coordinates (LF, SF, PCS) (Type & %)

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CHAIN OF CUSTODY 17. Relinquished By: 18. Date 19, Time: 20. Received By: 21. Date: 22. Time: 23.Method ol Submittal: FIELD I IS III 2 WALK IN US MAIL FEDEX__________ UI OTHER

LAB INFORMATION 24. Name and Signature 25. Date; 26. Time:

24a. Analyzed By:

240. Analyzed By:

24c. QCBy: JMLiazaiB NY-13 (3/99)

CITY_21MC100_003076969

NYC-WTC_000232328