NYC 9/11 Public Portal Document
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF ENVIRONMENTAL COMPLIANCE
ASBESTOS AND LEAD CONTROL PROGRAM
59-17 JUNCTION BOULEVARD
CORONA, NY 11368
JOEL A. MIELE. SR.,P.E.
COMMISSIONER
BULK
ANALYSIS CHAIN OF CUSTODY
y
Incident No.: Date Sampled: "1 o 2.—
Premise: 5 5, W -iZ S Boro: fri N
1 ~,O
Time• am~
Inspector:
Print Signature
Turnaround Time: Immediate 1+ 24 Hours I I 48 Hours I 1 1 Week I I
SAMPLE NUMBER I I DESCRIPTION LOCATION SAP►(PLED . I AB #I)
1. ). VI o Not o Q ao
p
2. l "1 L Q.'+ C ~•,n a { C~a~
/
3.-yd
•)-?-1 l o o %3 y 1
4. a -o L,o C*
fl J u ti 0
I
ANALYSIS REQUESTED: Asbestos PLM I Asbestos TEM I I Lead I I
Date _ imr Atxe ted By 1.
1. am Print
pm
Sign
2. am Print
pm
Sign
3. am Print
pm
Sign
4. am Print
pm
Sign
5. am Print
pm
Sign
DEP ACLP REVS/00
E NTERED
NYC-WTC 000113160
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