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
Incident No.: Date Sampled: "1 Dy
p~
Premise: 5 E, W r42c 1~ S Boro• M ►v
1 ~,D
Time: am1pil)
Inspector:
Print Signature
Turnaround Time: Immediate ke 24 Hours I I 48 Hours I 1 1 Week I I
SAMPLE NUMBER I DESCRIPTIt?N 1 LOCATION SAMPLED I LAB I
1.
2. _0 11_ '& t.i F (.4
3.—o ti t oI > y
4. ( -o C o Dl
S.~Z~ (b o u ti 0
7.
8.
9.
10.
ANALYSIS REQUESTED: Asbestos PLM Asbestos TEM I I Lead I I
Date Time Aece ted By Comments .. _ .
I. 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
ENT ERED
NYC-WTC 000113160
OCR can misread numbers and units. Confirm readings against the page image before using them.