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Asbestos bulk analysis chain of custody form

Machine-extracted title · confidence 95%

Department of Environmental Protection form for tracking the chain of custody of asbestos bulk samples submitted for laboratory analysis.

NYC-WTC_000186771
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Scanned page image, NYC-WTC_000186771
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NYC 9/11 Public Portal Document

DEPARTMENT OF ENVIRONMENTAL PROTECTION bureau of environmental COMPLIANCE ASBESTOS AND LEAD CONTROL PROGRAM 59-17 JUNCTION BOULEVARD CORONA, NY 11368 JOEL A. MIEU;.SIUP.C. COMMISSIONER ^^PLICATE BULK ANALYSIS CHAIN OF CUSTODY Incident No.: ____________________________________ Date Sampled: ^^^3/^22

Premise: Boro: /n/>h\/ Z^r^pm Time:

Inspector: ^^R/VF27W7^7L Print Signature

Turnaround Time: Immediate [ 24 Hours | 1 48 Hours | | 1 Week I 1

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8. ^223<5^^ Q0e>{^ ijLje^ Ccrri^r /s'? 9- 2^223009 I/O 10.

ANALYSIS REQUESTED: Asbestos PLM | Y ] Asbestos TEM | | Lead | |

____ mow Comments Si am Print

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2. am Print pm Sign

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4. am Print pm Sign

5. am Print pm Sign Dtp ACLP RFA 5/(M»

CITY_21MC100_002942479

NYC-WTC_000186771

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NYC-WTC_000186771Source: NYC Law Department, mirrored locally

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