NYC 9/11 Public Portal Document
EPARTMENT OF ENVIRONMENTAL PROTECTION
DASBESTOS
IjREAU OF ENVIRONMENTAL COMPLIANCE
AND LEAD CONTROL PROGRAM
59-l7 JUNCTION BOULEVARD
CORONA, NY 11368
40ft A. MIELt sass.
cOMMIWONZR
BULK
ANALYSIS CHAIN OF CUSTODY
Incident No.: Date Sampled: f) 2 .~~ Z
Premise: 32 wA RED! S`7 E6 T Boro: /rl lM 77v/
Time: II : 2' A/ Sa m
Inspector
Print Signature
Turnaround Time: Immediate I✓ I 24 Hours I I 48 Hours I I I Week I I
=SAMPLE NUMBER . .." <' DESCRIPTION I LOCATION SAMPLED I LAB ID
1.____6 ' 0/q Kraus Wf'
2. 2022!, 4O~o 02.0 rr ,r
3_2.o-2-4 ,.p6o d
4. 2Q Z2 4-r 102 2- a fi
S. 2022. 6o 023 . ri N
6. ,20ZL ,4o60 021. a fr
7. 202 /Icce, 02S
8. Z.OZL44 ,_ 60 ,off r, ,,
9. 202t~ Ac4v 7-z7 'brws w
l0.
ANALYSIS REQUESTED: Asbestos PLM I Asbestos TEM I I Lead I I
Date ` Time Bti C~ust:cntx
I. am Print
pm
Sign
2. am Print
pm
Sign
3. am Print
pm
Sign
4. am Print
pm
Sign
S. am Print
Pm
NYC-WTC 000122080
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