NYC 9/11 Public Portal Document
JCB (MAIN Uf UUSTUDY 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
Project Name: bC ~I lkcc Project Manager K r
101.4 Colin Drive, Holbrook, NY 11741
4~~ Sampler (Signature):
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Project Location: 9 .. , Samplers Name (Print): 40
Client Name: C'f (i z ` ;: J'. Project Number ❑ 6 HR 012 HR 924 HR 048 HR 072 HR 04 DAY 05 DAY 06-10 DAY
SAMPLE IN9J Project Phase A=Air =Bulk W=Water I=Wipe Time (min.)—- FUmin; Liters Analysis Analysis Date
Sample ID Date Type Sample Location 1 Description Lab # Start I Finish I Total Start Finish I Volume 1 Method MDL s/mm2 s/cc
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Relinquished by (Signature): Date Printed Name & Agent: Relinquished by (Signature): Date Printed Name & Agent:
Time Time
Relinquished by (Signature): Date Printed Name & Agent: Rec ' rL nature: Date/q,b Printed Name Agent:
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Comments & Special Instructions
Fax Results to 631-584-3395
White - Laboratory Yellow - Office Pink - Field
NYC-WTC 000097862
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