NYC-WTC_000232417

NYC 9/11 Public Portal Document

Taylor environmental group, inc. 130 JERICHO TPKE., FLORAL PARK. NY I I 001 5 16-358-2955 Fax 516-358-1780

LEAD SAMPLING DATA AND CHAIN OF CUSTODY DOCUMENT CLIENT NAMEZADDRESS C-4 CONTACT: SAMPLER (SI^^URE) Sate toe SAMPLE(S)

SAMPLER &£J£^T)\ rc SEALED YES / NO

CVS PROJECT LOCATION; PROJECT # MATRIX (CIRCLE ONE)(^^^^^^wipEA)P'^NT SOIL OTHER / SAMPLE INFORMATION: (FT^I SURFACE MATERIAL lABRrsuLi b 1 LABORATORY # SAMPLE # LOCATION WOOD METAL BRICK OTHER 7 id -o \ tOfe-rSogo^y Zg l-o ZC CZofeK Z<5J-oZ 'sC^’Vv5T>-zo - .AI^>sSt2> Q.^ '2-^ l-o £ I • o -O -Y -O

f- •

O ■

H K TURNAROUND REQUIRED: c/mments atNStructionT , I I I—i NORMAL Q STAT Q

relinouished4^gnature) DATE-:^^^j^PRINTED nXmE \ RECEIVED BY (SIGNATURE) DATE PRINTED NAME o o I TIME o o RELINQUISHED BY (SIGNATURE) DATE PRINTED NAME REVIVED BY LAB (SIGNATURE) PRINTED NAME CO CT) TIME < TIME^ cn CO CJ1 WHITE - OFFICE / YELLOW - LAB / PINK - CLIENT /f/: Tv/

NYC-WTC_000232417