NYC-WTC_000209324

NYC 9/11 Public Portal Document

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Z CUSTOMER, seNPy^Ta^^^^^^g^ CHAIN OF CUSTODY APL A AQUA PRO-TECH M l oRATORIES ,U PAGE-I._OF_< TURNAROUND TIME Certified Environmental Testing □ APL STANDARD Is 1-2 weeks 1275 Bloomfield Avenue • Building 6 Fairfield. NJ 07004 PHONE: iJoVl'bCY. jJ Y/ I oo' I ■pHOife; 'O-vz') foY toot'.? QOW - ® RUSH turnaround available upon request end lab approval. 2.*-i -fftT______ f

FAX: FAX: REPORT FORMAT 975-227-0422 1 Fax 975-227-2813 Uir- oU© (ml- Db$o ® STAlilDARD PROJECT NAME: C3 NJ DEP REDUCED DELIVERABLES I CONTAMINATION LEVEL PROJECT MGR.: Q'iZ, SENDrINVOICETO: ADDRESS: <,&/Sk □ NJ DEP FULL DELIVERABLES U ELECTRONIC DATA DELIVERY D HIGH Q MEDlfcll^'" i^LOW P.O. NUMBER SAMPLEDBY: SRP#_______________ .. ta STATE FORMS NEEDED J' M(ATRIX ABBREVIATIONS: D \"DRINKING WATER .Yl AQUEOUs': SVSOIL SL\ SLUDGE i

5 TYPE mHa 10 0-- a R- C REQUESTED _____ ft ? i Hiniis _____ ______________________ .r I* M, A I IlA-n'Vqc^'L L iScLd'^'X SV Mj lift. .1 Su 1 e. 1 S&V Xs ' 'ip'Ys. 4——^— try ..4^1 ' ■ ' -rZ ' ; ,7

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^RELINQUISHED BY (Print) DATE»« ria I RECEIVED BY (Prinl)' DATE/^ TIME 2 :y/ANl<^ . SignalurafAgent of: y/zi lAu ' TIME 1?.»i|AM.^ SignatyrefAgent of: RELINQUISHED BY (Print) * Z. DATE J I RECEIVED BY (Print) DATE I /

I : O' bO Signature/Agent of: . RELINQUISHED BY (Print) Signaturs/Agent of: . TIME DATE " TIME I AM PM t ' AM PM SignaMAgent of: RECEIVED BY (Print) Signatur^Agent of: TIME. DATE TIME I AM PM / AM PM X COMMENTS ( SPECIAL INSTRUCTIONS I I o CERTIFICATIONS: NJDEP #07010 NYDOH #11634 CTPH#0233 US ARMY NELAP (APPLIED)

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NYC-WTC_000209324