• DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF ENVIRONMENTAL COMPLIANCE
ASBESTOS AND LEAD CONTROL PROGRAM
59-17 JUNCTION BOULEVARD
CORONA, NY 11368
JOEL A. MIELE. SR-►.L
COMMISSIONER
BULK
ANALYSIS CHAIN OF CUSTODY
Incident No.: Date Sampled: _1— -4 o2
Premise: 11 B4 T~ ~-~C Boro: M 'NNA-t=\A_
E 3
Time: 1 2O (amlpm
Inspector: r1fl E>' -A ~4YV►. eLQL—
Print Signature
Turnaround Time: Immediate I 24 Hours ) ) 48 Hours ) I I Week I )
SAMPLE NUMBER DESCRIPTION LOCATION SAMPLED I I LAB ID
I.~o;Z2-t ~3go01 I baro14S Q.ol,~,~. 0,.
2. O 22 pv pnZ L
3. Co 04
4- 0.2 AQ3$ av -I
5
6. Jo)34 oa6
7. 20i- -i frO3% 001
8. 02~{
9. o3~SoE09
io. 20 tZjjAo38 0t o
ANALYSIS REQUESTED: Asbestos PLM I'/) Asbestos TEM I ) Lead I I
Date Time Accepted 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
0
NYC-WTC 000119273
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NYC-WTC_000119273Source: NYC Law Department, mirrored locally