00
20230
ILAND
ANALYTICAL
LABORATORIES INC.
101-4 Colin Drive • Holbrook, New York 11741 • Phone (631) 472-3400 • Fax (631) 472-8505 • Email: [email protected]
M AKALYTICAL SOLATIONS TODNS®
CHAIN OF CUSTODY / REQUEST FOR ANALYSIS DOCUMENT
CLIENT NAME/ADDRESS
CONTACT:|VETTER
SAMPLERYSIGNATURE)
DATE
TIME
SAMPLE(S)
SEALED
ENVINOSPECT
90 LAWRENGE AVE.
PHONE: 631366-5294
225-0z
1145
AMPLERRIAME (PRINTI
CORRECT
SMITHTUNN, NI. 11787
FAX: 631 366-588)
CONTAINER(S)
PROJECT LOCATION:
O2ElS
LAnnT
VETTEn
NEw yonK CITY
TERMS & CONDITIONS: Accounts are payable in full within thirty days, outstanding balances accrue
service charges of 1.5% per month.
LABORATORY
MATRIX
TYPE
PRES.
SAMPLE *•
LOCATION
ID#
ANALYSIS REOUIRED
AGBESSOS
d A11146
31
BAIK
A11147
3) FRONT
X
A11148
33 NOnTu
AlLY9
33 SOUTA
AllsO
33 EDS5
BIILS1
33 WEST
YES( NO
TES
/ NO
NYC 9/11 Public Portal Document
#OF
CONTAINERS
MATRIX S=SOIL; L=LIQUID; SL=SLUDGE; A=AIR; W=WIPE; P=PAINT CHIPS; B=BULK MATERIAL
TYPE G=GRAB; C=COMPOSITE, SS=SPLIT SPOON PRES ICE, HCL, H2SO4. NAOH
RELINQUISHED BY (SIGNATURE)
Xana
1478602
PAINTED NAME
1030
LANNY A VETTER
RELINOUSHED BY (SIGNATURE)
DATE
PRINTED NAME
TURNAROUND REQUIRED:
NORMALD STATĂ BY 2 127/02
RECEIVED BY LAB (SIGNATURE)
COMMENTS / INSTRUCTIONS
RECEIVED BY LAB (SIGNATURE)
Discluschbe
WHITE - OFFICE / CANARY - LAB / PINK - SAMPLE CUSTODIAN / GOLDENROD - CLIENT
DATE
PRINTED NAME
TIME
DATE 2/26
/PRINTED NAME
TIME
10:29
NYSDOH ELAP# 11693
•USEPA# NY01273
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000120230Source: NYC Law Department, mirrored locally