NYC-WTC_000232407

NYC 9/11 Public Portal Document TAYLOR ENVIRONMENTAL GROUP, INC. 130 JERICHO TPKE., FLORAL PARK, NY 11001 Ba leh Elo7/S 5 LEAD SAMPLING DATA AND CHAIN OF CUSTODY DOCUMENT CLIENT NAME/ADDRESS CONTACT: SAMPLER (GNATURE) DATE TIME SAMPLE({S) ites) f . . . 7[r7/or SEALED NO Mw YC ScA Hae LN Av o\ SAMPLER[NAME JPR) CORRECT \e . NO Vas eke jae ea CONTAINER(S} CED PROJECT LOCATION: wy Vv esant y-S | PROJECT 4 MATRIX (CIRCLE ONE): Ses CAambew St rT. [1 “77-13 A }-2 99S | | Gwe — PAINT SOIL OTHER AMPLE IN T ° SAM FORMATION: AREA {FT2} SURFACE MATERIAL U4 LAB RESULT LABORATORY # SAMPLE # LOCATION WOOD] METAL] BRICK | OTHER C4 L ROOM oF 26 -Ce. WY \ y ‘ - e J EWI 0 | Cun by - Dm per Comport < 4. T FeL-( Fiel Bl mee .~ C ). - : pt 0) PELL Field Blob ! OQ H re, TURNAROUND REQUIRED: COMMENTS / INSTRUCTIONS Do a norma} stat ay / / rR 5 _ 6 HR TAT 5 RELINQUISHED BY (SIGNATURE) _ DATE 7/28 (| PRINTED NAME RECEIVED BY (SIGNATURE) ONE ef PRINTED NAME ° | TIME 2 eie N © epic | AIC La / TIME OF x). Ko gal BS S RELINQUISHE fB) |SIGNATURE) ONE oa PRINTED NAME RECEIVED BY LAB (SIGNATURE} DATE PRINTED NAME w . >) ° TIME fica c — Jee weic. TIME Ww “wT Rr WHITE - OFFICE / YELLOW - LAB / PINK - CLIENT NYC-WTC_000232407