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Lead sampling data and chain of custody record

Machine-extracted title · confidence 85%

Form recording lead sample identification and chain of custody details for environmental analysis.

NYC-WTC_000186026
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Scanned page image, NYC-WTC_000186026
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OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document

M ■■ H Taylor environmental group, inc. 130 JERICHO TPKE., FLORAL PARK, NY I 1001 ,2 li /'.f 516-358-2955 Fax 516-358-1 760

LEAD SAMPLING DATA AND CHAIN OFyCUSTODY DOCUMENT CUENT NAME/ADDRESS QCj\ CONTACT; < , SAh'J-lER (SIGNATUI SAMPLEJSJ SEALED YESy NO SAMPIEE NAaSe (ft^n CORRECT CONTAINER(S| NO PROJECT LOCATION; PROJECT # V MATRIX (CIRCLE ONE); (\y|P£) paint SOIL OTHER

SAMPLE INFORMATION; /V?EA (FT’) SURFACE MATERIAL LAfl RESULT LABORATORY # SAMPLE # LOCATION WOOD METAL BHCK OlHER

CotT I s

g-OS-^A 0/5" . Q. OtA S-CC U\

<sV\ ■2J?-

O' \\ > K I

o PRINTED N I TURNAROUND REQUIRED: NORMAL □ statQ

RECEIVED BY (SIGNATUREJ BY F DATE COMMENTS / INSTRUCTIONS

r.o PRINTED NAME o I o TIME TIME DATE PRINTED NAME RECEIVED BY LAB (SIGNATURE) DATE PRINTED NAME o co TIME TIME WHITE • OFFICE / YELLOW - LAB / FINK - CLIENT

NYC-WTC_000186026

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NYC-WTC_000186026Source: NYC Law Department, mirrored locally

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