NYC 9111 Public Portal Document
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CHAIN OF CUSTODY DOCUMENT Expected Date of Completion
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J.C. Broderick & Associates Bill To: J.C. Broderick & Associates -
Laboratory:
101.4 Colin Drive, Holbrook, NY 11741 Accounts Payable
631-419-0913 • Fax: 631-584-3395 101.4 Colin Drive, Holbrook, NY 11741 `~~
Project Name: q Hurray J/ Project Manager ~~le.V Kiork \avl Sampler (Signature): Lius Gt,rieU
Project Location: I -14r,-c f. ,Y Samplers Name (Print): . L cp VL-2.,J3_;
Client Name: q N1,.~ rrG 5fi Project Number OV- ei -1 ❑ 6 HR EK12 HR 024 HR 048 HR 072 HR 04 DAY 05 DAY 06-10 DAY
SAMPLE INFO Project Phase A=A' B=Bulk W=Water I=Wipe Time (min.) -E-L/min-*► Liters Analysis Analysis Date
Sample ID Date Type Sample Location / Description Lab # Start Finish 1, Total Start [Finish Volume I Method MDL •`: slmm2 s/cc
1 IorgJ/ f} l), tQ-eST act- 't~gs%d~Q RaoC al$ 12w1`t:IS 135" 1 - I5 ;202.5": lvo (S Q4 ~. oa.
2 ►J o,'yea a-(-~ L R-so a13b 12101 I. 4 tro (a5 IS (5 s2o2S'
3 I so c.t'pt c.)2 a r.t O .~ Roof dl$o7 (z:oZ lit ; ri ' 135' 15 l S .2
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4 Sc ectS r oL" tzoo $ Z;o :1`t1 18; 13x' 1ST l5 2oZS
5 icy k~e u,-,i A t2 f___ I2,OS IK 12 V . tS IS € ao2S
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Relinquished by (Signature): Date Printed Name & Agent: Relinquished by (Signature): Date Printed Name & Agent:
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Re inquished by (Signature): Date Printed Name & Agent: Rece' d for bb n Datel t -~J Pri ted Name & Agent:
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Comments & Special Instructions
Fax Results to 631-584-3395
White - Laboratory Yellow - Office Pink - Field
NYC-WTC 000097873
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