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Lead wipe chain of custody form, Mar 28 2003

Machine-extracted title · confidence 95%

Chain of custody documentation for lead wipe samples collected at 100 Church Street on March 28, 2003.

NYC-WTC_000174643
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Scanned page image, NYC-WTC_000174643
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OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document )

C4

LEAD WIPE SAMPLE DaTa AND CHAIN OF CUSTODY FORM GJ CM Sr; GJ

Ld aionl PagB-, Project Name S Address; TRC Field Represenlalive: T New York City Law Department 100 Church St Zibby Dolinski fv' lofl Dale: Requeslad Turnaround Time; TRC Project Managei: TRC Projecl No; 03/28/03 12 Hrs NITIN DAVE OFFICE PHONE: (212) 221-782-2 35052-0000-00017 CELL PHONE; (917) 549-3382

WIPE SAMPLE INFORMATION Sample Location Aiea Sampled TolflI Area 3 Sample Number. Surface Descriplion. Inches (Sq in) Floor RoomfArea Description

J ZDD.32!)O3LW2O(11 12 X 12 144 20'" Floor

ZD03Z803LW2O02 12X 12 144 20"’ Floor I

ZD03Z8D3LW2b03 . 12X 12 144 20'" noor

Z0032e03LWZ(104 Field Blank

r . 03

X>r- r-1-x^ vO

"S’ I I_____________ _ Tsi S5: SPECIAL INSTRUCTIONS TO LABORATORY 1\3 > no Fax Resrills To (Name) NiTIN DAVE at (Number) (212) 221-7840

CHAIN OF CUSTODY DOCUMENTATION AND LABORATORY INFORMATION Relinquijiied By---- Dale Time Received By Dale Time Melhcd of Submillal Commente (Lab) / >Ar^Z

H I. Zibby Dolinski Field □ EMSL EPA METHOD 3050^420 O3/28Z03 1^_____________ _ Walk In Anaiysis to/ lead only Time to II. US Mail U Name and Signature: Dale S o Fed-Ex □ Analyzed By:

guT Olher u Analyzer) By y L I.

ro CT CJ1 co IXJ co <71

NYC-WTC_000174643

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NYC-WTC_000174643Source: NYC Law Department, mirrored locally

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