Microecologies lab fax cover sheet, Nov 2001

NYC-WTC JCB CHAIN OF CUSTODY DOCUMENT J.C. Broderick & Associates Bill To: J.C. Broderick & Associates 030106602 Expected Date of Completion 10-19-01: 101•4 Colin Drive, Holbrook, NY 11741 Accounts Payable Laboratory: 631-419-0913 • Fax: 631-584-3395 101•4 Colin Drive, Holbrook, NY 11741 Ambiau s Project Name: 69 Murray-St Project Manager Kevin Sampler (Signature): Lyushneuskiy Project Location: 69 Murray St. N.Y. Samplers Name (Print): Igor Lyustneuskir Client Name: 69 Murray St Project Number D6HR X12 HR •24HR [48HR [72 HR •4 DAY [5 DAY []6-10 DAY SAMPLE INFO Project Phase CA=AiD B=Bulk W=Water I=Wipe « Time (min.)→ *L/min Liters Analysis Analysis Date Sample ID DateR Type Sample Location / Description Lab # Start : Finish | Total Start |Finish| Volume 1 Method MDL | s/mm"| s/cc 10/10/01 A Inside room by the ent. door 18:302045 135 10 11350 Inside room by the bathroow 18131|20:46|35 10 10 |1350 Iuside kitchen room 8:3320:47135 10 10 1350 Inside living Room 18:3 20:50135 10 10 :1350 Iuside Gym Roau 18:38.20:53135 10 10 |1350 F.B F.B 7 NYC 9/11 Public Portal Document 10 11 12 13 14 15 Relinquished by (Signature): yushneuskir Relinquished by (Signature): Comments & Special Instructions Fax Results to 631-584-3395 Date 10/19/01 Time Date Time Printed Name & Agent: Printed Name & Agent: Relinquished by (Signature): Received for Lab by (Signature): ED@Erse Date Time Doialor Time 1:59PM Printed Name & Agent: Printed Name & Agent: White - Laboratory Yellow - Office Pink - Field