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
OCR can misread numbers and units. Confirm readings against the page image before using them.