NYC 9/11 Public Portal Document
q?09
NEW YORK CITY HOUSING AUTHORITY
CTIONAND ABATEMENT UNIT
LEAD DE EO
D LE CHAIN OF CUSTODY
Date __- .. Inspector's Name ... Contract #................
—. ~C.~- -_--..-/
Development -----6, hreG_ ...................................... Release #...I .......................
Address ZSO Fax to (718) 787-5255: Attn: Raphael I
Apartment/Facility Type .... ..........................................•-•._.._.•.--••-...-..._.... RePort/Bills must be submitted to:
NYCHA-Technical Services-LDAU
EDP #--O ~..-,----. SH #..-_/,.___..._. CI ..---•--•-•-•-•.. 23-02 49th Avenue, 5d floor
LDAU Ticket #/Note: ...............................................................................• Long Island City, NY 11101
Clearance Categories:
3. Exterior Work On Painted Surfaces 5. Soil Work
1. Interior Treatment without Containment Apartment ~`" i
2. Interior Treatment with Containment 4. Routine Maintenance 6. 504
lij ~~~ J 11YL:
SAMPLE ID ( EM ,-p SURF CE TYPE DIMSIt
(Month-Date-Initials-No.) (in i hE
~c/• a ~I,i' e~ FL WS ST SL
Qr ~1 er. /
~` ` - (/ /Zc - -- fc9p BLANK
{ .S W sT L
If~~ H+. -'J !O : 3 /~• .
-- f /tZo l o : ~7~" IFF W
-- r - FL WS ST SL X
G.~ • r Other
FL WW ST SL X
-- -- -- ~/ /~'L/y /• 3~v S
FL WS WW SL X
-- - -- Other.
FL WS WW ST SL X
-- -- Other:
FLWS WWSTSL
-- -- -- Other.
FL WS WW ST X
-- -- -- Other.
FL WSTSL X
FL WS WW ST SL X
-- -- -- Other.
L WS WW ST SL X
0
FL WS W ST SL X
-- -- -- Other.
FL WS WW ST X
-- -- -- Other.
FL WS WW ST SL
-- -- -- Other.
FL WS WW ST SL X
-- -- Other
FL WS WW ST SL X
-- -- Other.
FL WS WW ST SL
-- - Other
FLWSWWSTSL X
-- -- -- Other
=STAIR TREAD; SL = STAIR LA?'
ABBREVIATIONS: FL =~FLOOR; \VS — VIN W SILL; WW =WINDOW WELL: ST
Sampled By: ............( ..
'-
` ...4'-. .. ... .. ...
......................Date: .. . ( ..........Time: .. .
Relinquished By: rit ~ •_.:•=j•
..........IQ... Date: ...?....................Time:
..` 1.. ...o ....Time:
...................................Date: .5.. -f'~ ! 1 ...Time: ............
Received By:
Date• ....................................Time: ............
Analyzed By:
Total number of samples on this p,
Required Turnaround Time (TAT) is hrs
NYC-WTC 000106073
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