NYC-WTC_000209705

NYC 9/11 Public Portal Document

I/I.^OIT L.»»,r}Of..,.u.NIAu uhOUF, ii'tC. I 30 JERICHO TPKE., FLORAL PARK, NY I 1001 5 16-356-2955 Fax 516-356-1700

LEAD SAMPLING DATA AND CHAIN OF CUSTODY DOCUMENT SAMEOTISiGnAIUJIEI DATE, CLIENT NATiJE/ADUfiESS CONTACT; IIME SAMPLE(S) n Yc #7— SAMPLER flAME |FRINI) \ / SEALED

CO^ERISI (S5>NO E9/ NO

PROJECT LOCATION; (-l-^ PROJECT # MATRIX (CIRCLE ONE|: pajnT SOIL OTHER

SAMPLE INFORTVIATION:' MEA|FP| SURFACE MATERIAL LAD RESULT . , „ lABORATORY « SAMPLE « LOCATION WOOD Mt TAI BRICK OITICR — -O I I I y.'O /<2//

7 I / YY 4 aa LbJ - oi>'' I o /02 ^clYL 5*7 O LU-Di I m "O

§ LU-07 I O ZT DO t'G '?//, -0? I 'S Yf/ m/dY ven [ - □fc s Yl >

(= relit^is/ed by ISIGNATUREI PRINTELJ NAME / ‘ TURNAROUND REQUIRED: NORMAL 0 STAT Q „/ / DATE COMTvTENTS / INSTRUCLIONS

ff T^ 'Z' PRII-TI ED NAME

□J TIME I ?tn) “0 tTeCEIVEO by lab ISIGNATURE) Y I RELINQUISHED BY (SIGNATURE! DATE PRINTED NAME DATE PRINTED NA/.IE o o o TIME TIME o o co WHITE ■ OFFICE / YELLOW - LAIT / PINK ■ CLIENT on

NYC-WTC_000209705