NYC-WTC_000199503

NYC 9/11 Public Portal Document

iAYLOii ENVIRONMENTAL GROUP, INC. I 30 JERICHO TPKE., FLORAL PARK, NY I 1001 5 16-3S8-2955 0302)0 S’© 5 Fax 5I6-358-I780 CO

3 LEAD SAMPLING AND CHAIN OF CUSTODY DOCUMENT ? ----- --- -- - - _ _ DATA _ 13 CUENi NAME7ADDRESS SAMPIER (SIGtWjREI 1IL-4P MN TACT; 0 5AMPLT(S| YES 4 NO R SEALED SAwPLER'jWuTtnnftii CORRECI Zvc'X COMIAINER(S|f YtiTPrCJ a’ PROJECT LOCATION: PROJECl V MATRIX (CIRCLE ON^ ^PE J PAINT SOIL OIKER

___________ 7 SAMPLE INFORMATION; LABORATORY # SAMPLE y

c, GxS<C) LOCATION AREA (Fr?| SURFACE fvVXTERIAL V/OOD METAL DfiiCK oniER 1AHRE5UL1 Z23 t -1

O'

1 ^\zA(C Cfo C 1 lO’O O'

1/9 ■ Y. S-) 3 ’^loOW \ Vcv - Q- \ <t. *^13 A • ^)oo< 'T-VP<

^-3 1 ^3 lO • O Y I '3 V loUT C312 ! \ Caj VO • O 3 Si; 5 I ------ \ -g-Xs T:' Cp V J I

-FVi'-l VW <A Q H V (^"2 ■ Y.W 2. ’ ^£0^3^ I K O-feo IURNAROUND REOIJIRED: COWMCNIS / INSIflUCIIONS NORMAL Q STAT O BV S O ISIGNATURE) DATE. / / o o REIINQUISHEO oy IJ)0NATURE)

IIME PRINIED NAME RECEIVfiD BV (SIGNATURE! ERIN I ED NAME i 1 o ECeWeD BV lab (SIGI'AiIIRH' o RELI^UISHEf^^^SIGIIAIUREI DATEgr y.o ^PRINIED NAME RECE daie PRINTED NAME co o IC. IIME ri/.if co cn WHITE - OFFICE / YELLOW - LAB / PINK CLIENT o

NYC-WTC_OO0199503