NYC 9/11 Public Portal Document
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Fatrtkid, CT 06430-6531
(203) 3194089
Lead Bulk Sample Data Sheet ! C.O.C.
Colden Corporation Project No: O2..LoO Client:' Battery Park City Parks Conservancy
Project Name: Wc-5+-1-'r i N
Date of Sa iple Collection: ~„ Samples Collected By: J obart R. Van Deusen
Samvte I.D.: Sample Location: MariaL Lab toot' AnatysY~
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en Yavoice to: Colden 100.N. 17 St., 9 , Philadelphia, PA 19103
Pax Results to: Rye Van Deuseti at (208) 692-6091 O Fax , results to:GreeRlcheY at (215 4 1 k
Laboratory Name: ?ash SAMPLE TAT: Questions CALL: 111
Samples Relinquished to Lab bys _\k 5n
Date: J2 - ° 7-- (Print Name) )
Samples Received at b by: YY\ M < o7`•f
Date: V (Print arse) (Signature)
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NYC-WTC 000130940
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