NYC 9/11 Public Portal Document
LABORATORY^ NAME
CHAIN OF CUSTODY RECORD
CITY OF NEW YORK
PAGE OF.
DEPARTMENT OF ENVIRONMENTAL PROTECTION
CONTRACT NO. D IVISION OF EMERGENCY RESPONSE AND TECHNICAL ASSESSMENT
96-05 HORACE HARDING EXPRESSWAY, ELMHURST, NY 11373
PROJECT LOCATION CASE NUMBER.
PROJECT NAME DATE OF SAMPLING T/i/eZ-
ITEM SAMPLE CONTAINER TIME . . DESCRIPTION LAB ID #
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ITEM RESULTS REQUESTED WITHIN
ANALYSES REQUESTED COMMENTS
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PERSON RESPONSIBLE FOR SAMPLE: AFFILIATION:
TRANSFER ITEM TRANSFERS TRANSFERS
« DATE TIME COMMENTS
# RELINQUISHED BY ACCEPTED BY
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TO ACKNOWLEDGE RECEIPT OF SAMPLE[S). PLEASE SEND ONE COPY (COLORED PAGES) TO THE DERTA AT THE ABOVE ADDRESS, ATTENTION SAMPLf
CUSTODIAN. IF YOU HAVE ANY QUESTIONS, PLEASE CALL (718) 595-4784
CITY_21MC100_003074620
NYC-WTC_000203101
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