D1 PARTMENT OF ENVIRONMENTAL PROTECTION
RL?REAU OF ENVIRONMENTAL COMPLIANCE
ASBESTOS AND LEAD CONTROL PROGRAM
59-17 JUNCTION BOULEVARD
CORONA, NY 11368
JOEL A. MIELE. SR~.E.
COMMISSIONER
BULK
ANALYSIS CHAIN OF CUSTODY
Date Sampled: .1_" ~N OT .
Incident No.:
Premise: ri e -P Thy FrL cE Boro: M P -t..) H Ni Cm
-t.,)
Time: °O am II
Inspector: Sfrr N
Print Signature
Turnaround Time: Immediate Iv I 24 Hours I I 48 Hours I I I Week I I
SAMPLE NUMBER ` ' DESCRIPTION LOCATION SAMPLED LAB ID
~Q f }y.7 } /s G
r 1 d~l S