69 MURRAY STREET Block: 132 Lot: 3 BIN: 1001420

NYC 9/11 Public Portal Document

JCB CHAIN OF CUSTODY DOCUMENT Expected Date of Completion, • J.C. Broderick & Associates Bill To: J.C. Broderick & Associates 101.4 Colin Drive, Holbrook, NY 11741 Accounts Payable Laboratory: 631-419-0913 • Fax: 631-584-3395 101.4 Colin Drive, Holbrook, NY 11741 Project Name: Project Manager Sampler (Signatur : - . Project Location: j a Samplers Name (Print): Client Name: Project Number 7 ❑ 6 HR 012 HR 024 HR 048 HR 072 HR 04 DAY 05 DAY 06-10 DAY SAMPLE INFO Project Phase *A=Air B=Bulk W=Water l=Wipe •F -Time (min.)-*- - K - Umin—*• Liters Analysis Analysis Date Sample ID Date Type Sample Location / Description Lab # Start Finish i Total Start :' Finish i Volume Metho MDL ( i

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i '• : I , Relinquished by (Signature): Date Printed Name & Agent: Relinquished by (Signature): Date Printed Name Agent: Time Time Relinquished. by (Signature): Date Printed Name & Agent: Received for Lab by (Signature): Date Printed Name & Agent: '. Time Time Comments. & Special Instructions Fax Results to 631-584-3395: ' : .. White - Laboratory Yellow - Office Pink - Field

NYC-WTC 000097836