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NYC-WTC_000196103

Label derived from the City's folder field. The City does not supply document titles.NYC-WTC_000196103–000196104
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NYC 9/11 Public Portal Document PURTE.. 1. IROK AL 39 W38™ STREET, 12™ FLOOR NEW YORK, NY PHONE. 212 768-0516 FAX: 212 768-0759 PROJECT INFORMATION (fill out ALL information) ASBESTOS BULK SAMPLING AND CHAIN OF CUSTODY FORM Page 2 of 2 CLIENT: PROJ. NAME: ; PROJECT #: DATE: S/O BROADWAY O0)-090) |. G/ESSC/ CLIENT ADDRESS: PROJ. ADDRESS: ¥ , 7 7 /76 BRabwty NY MY WORK AREA: Comments: Turnaround Time: Method of Submittal: INSPECTOR: TS BE 5 STAT 6HRS 18HRS FIELD 7% USMAIL Tepay MANAGER: 3 COX S MAW 24HRS 72HRS OTHER FEDEX OTHER ‘ ‘ 7 oO We a HA # | Sample ED # Lab ID # Material Description Sample Location Quantity Friability Results (incl. color) (SF) YIN TG OIE > ./f 7 CHAWOTILG TH live ott Dttsi Sosiclee slpr. JOC Tan 7 _f - i CHAMOTEES [2 42) Dusr Lrsicle fier. fO'C 22. 4 re, CHAIN OF CUSTODY LAB INFORMATION N Relinquished By (Print/Sign) Date/Time Received By (Printv/Sign) Date/Time ; Analyzed By (Print/Sign) Date/Time z T, GROMSMANM EGP Ce GEfA J? = Andree bess Lh Bee, éPsfa pietta Andy bos, Lhe. Pesto lls. 4p, ° la) la) la) Ww la) ol is ol fee) iS NYC-WTC_000196104

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NYC-WTC_000196104Source: NYC Law Department, mirrored locally

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