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NYC-WTC_000205677

Label derived from the City's folder field. The City does not supply document titles.NYC-WTC_000205677
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Scanned page image, NYC-WTC_000205677
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NYC 9/11 Public Portal Document

CHAIN OF CUSTODY DOCUMENT Expected Date of Gompletiun JCB J.C. Broderick & Associates Bill To: J.C, Broderick & Associates * Laboratory; w I 11 1-4 Colin Drive, Holbrook, NY 11741 Accounts Payable I 1 j ■! 631-419-0913 »Fax: 631-584 3395 101 -4 Colin Prive, llolhr.yik,NY 11741 \ | W hj

[Project Manager Sampler (Signature): © Projecthte^

Project Location: sf^'4 A Samplers Name (Print): □ 6HR ni2HR^4HR^4aHR mHR 14 0AV QS DAY JJ0-1D DAY CifentName. ILS A _A P'ojacl Nkjniber JpfOject B=nutk W=Water !=Wp& SAMPLE INFO -* Hmc (min,)-*- Liters Analysis Analysis Dale 5 2 Sample ID Dale6 Type Sample Locatjon / rmsfirijjfci! Lab# start Finish ’ Total Start Rnislii Voturne j Mflfhnd WDL ; s/mm - 1 ael rR o 2 «/ll ft /O 3 it ij» >4 'ZB" fi) I/O I/l S § 4 jk ___________ ____________ ja 2 5 B —^Z<5— I> CO cn 7 ! 0 + 9 T fO 11 i 12 s

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■ i 16 __ L__ i_______ ! ■'o o Reliptjuisl^d byJSfgrjatur«).- Printed Name Agen!; flelinquished by (Signature), Dale Printed Name & Ageet:

I H K Time Time 5 Relinquished by (Stgjialure); Date Printed Name A Agefil; Received for Lab by (Bignalure); Date Printed Name & Agent: S D O Time Time __ r.a o o Comments & Special Instfuctiuns I o o Fax Results lo 631-584 3385 co o While - Laboratory Yellow - Office Pink - Field o co CD 41^

NYC-WTC_000205677

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NYC-WTC_000205677Source: NYC Law Department, mirrored locally

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