NYC-WTC_000200109

NYC 9/11 Public Portal Document “ -. J C_____ J Ii_.... _j c

Taylor environmental group, inc. 7j C73 Ca FT] . f J I 30 JERICHO TPKE., FLORAL PARK, NY I 1001 SI6-358-2955 Fax 516-358-1700

LEAD SAMPLING DATA AND CHAIN OF CUSTODY DOCUMENT CLIENT NAME/ADDRESS CONTACT: SAMPLER (SIGNATURE) A , DATE TIME SAMPLE|S| CAab=s=i^‘y^/^(/ SEALED YES)/ NO SAMPLER NAME (PRINT/’J ' /UL(C SSeSu2^/ no PROJECT LOCATION: PROJECT # MATRIX (CIRCLE ONE);^ wipe ) 50i. OTHER '5"i nL| 7" SAMPLE INFORMATION: AREA (FP) SURFACE MATERIAL > LAB RESULT LABORATORY # SAMPLE # LOCATION WOOD METAL BRICK OTHER

Lvo - 17 F A ^-.p op LO -O ________________ CA-lAv imTF

C-vsj" ru»i=. 507 7t?T oP LLm - QAr^frLb'^F

UvJ -YO. CD V ro "L 33- Co aA c: \ CT? XI Uv\) m -F\> o rri -“t-T- -o < m o cn 1 L v-J _ '^?TTC.v\ o

o 7b>T5'^Y<'. ■ H TURNAROUND REQUIRED: COMMENTS / INSTRUCTIONS F/jy /d ~ :2^35' hJ NORMAL □ STAT □ ~rK~r s o RELINQUISHED BY (SIGNATURE) DATE PRINTED Ri / PRINTED NAME o I o o ,^47/ TIME o RELINQUISHED BY^NA^dlRE)^^^^^ RECEIVED BY LAB ISIGNATURE) PRINTED NAME co DATE «g-.|-7.^;>2PRINTED NAME LO TIME {6-'70 '"T^iSS^A M TIME co WHITE - OFFICE / YELLOW - LAB Z PINK - CLIENT co

NYC-WTC_000200111