NYC 9/11 Public Portal Document
M
TAYLOR ENVIRONMENTAL GROUP, INC.
516-358-2955
130 JERICHO TPKE., FLORAL PARK, NY 1 100!
A i F ax 516-358.1780
LEAD SAMPLING DATA AND CHA1 * CUSTODY DOCUMENT
CLIENT NAME/ADDRESSaC ONTACT: SAMPLER _ NATURE+ DA E TIMELY SAMPLEISJ
' 0 J SEALED
SAM ER AIAE IPRIN CORRECT
CONTAINERISI YES / 0
PROJECT LOCATION: PROJECT
MATRIX (CIRCLE CDNE) PE PAINT SOIL OTHER
SAMPLE INFORMATION' I tURF CEMATERIAL i
AREA lFr?j TAB RESULT
LABORATORY N SAMPLE X LOCATION WD MErAL swat oT►iER
j= ~JCw
iii
m
U1
Ui r
r
t--t
I I r
O
__________ ___________ _____ _
TURNAROUND R CIUIRED: 1 COMMENTS / INSTRUCTIONS
NORMAL
R . £NED BY SI
SIAT ❑
.
BY
~:J
I
DATE '}
Th I~RIN D NAME
RELINOUISHE Y JSIGNATUREJ DAT -; PRINTED NA E / /;i /
G'"` /
"- `
TIME `. ~ [~A : l TIME
RELIT• UI H BY (SI IATUREI DATE-1IT` PRINTED NAME RECEIVED BY LALI (SIGNATURE) DATE PRINTED NAME
11
TIME `1'5 C TIME
v I WHITE - OFFICE / YELLOW - LAB / P1NKI- CLIENT
NYC-WTC 000106911
OCR can misread numbers and units. Confirm readings against the page image before using them.