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Document / 13 pages

Asbestos project notification form, Corona NY, Oct 2001

Machine-extracted title · confidence 90%

Project notification form for asbestos abatement activities submitted to the NYC Department of Environmental Protection.

NYC-WTC_000109630–000109642

Folder label: “115 West Broadway

Page image
Scanned page image, NYC-WTC_000109641
OCR text

OCR status: ocr · source: ours

000 09641 JCB CHAIN OF CUSTODY DOCUMENT J.C. Broderick & Associates Bill To: J.C. Broderick & Associates 101•4 Colin Drive, Holbrook, NY 11741 Accounts Payable 631-419-0913 • Fax: 631-584-3395 101•4 Colin Drive, Holbrook, NY 11741 Expecte 10/19 Laboratory: Emst<inil Project Name: 5 2784 Project Manager Ki Kotlay: Sampler (Signature): - Project Location: 115 west Brecdway Focf Samplers Name (Print): Basaa Client Name: Andíen Bld. Ceil. Project Number 22%4 •6HR •12 HRJ 24 HR •48 HR •72 HR •4 DAY •5 DAY •6-10 D. SAMPLE INFO Project Phase "A=Air(B-Bulk W=Water I=Wipe +Time (min.)», +L/min Liters Analysis Analysis Date Sample ID Date Type Sample Location / Description 19/x grey+ Briwn/ Nese Enszce. 10/85 gret- Fiberglnss- LNearo Duet wik ic/K grey Ash I Vorth side Roof Lab # A21723 A21774L A2172 Start | Finish I Total Start|Finish Volume! Method MDL s/mm? 1s/c ASBestos PIM1 I/m Aspistesa ASaEtos 10 12 13 14 15 Relinquished by (Signature): Relinquished by (Signature): Comments & Special Instructions LFax Results to 631-584-3395 Date rjg Time Date Time Printed Name & Agent: Relinquished by (Signature): Printed Name & Agent: Date Printed Name & Agent: Time Date 10-19 Printed Name & Agent: (rma 2" K. Trugla White - Laboratory Yellow - Office Pink - Field NYC 9/11 Public Portal Document

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NYC-WTC_000109641Source: NYC Law Department, mirrored locally

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