NYC-WTC_000232916

NYC 9/11 Public Portal Document TAYLOR ENVIRONMENTAL GROUP, INC. 130 JERICHO TPKE., FLORAL PARK, NY 11001 §16-358-2955 Fax 516-358-1780 42005 LEAD SAMPLING DATA AND CHAIN OF CUSTODY DOCUMENT CUENT NAME/ADDRESS CONTACT: SAI UIGNATUREY DATE TME SAMPLE[S} : - i 7, 23.04 SEALED Ey NO = ] Cc. &c& HAMID SAwWO SAMPLER WAVE (PRINT) CORRECT : q yas hich (és) NO COn/ Ze CONTAINER(S| PROJECT LOCATION: STUY wean Ls} Prosect # r MATRIX CIRCLE ONE}: PANT SOR OTHER 24s awn bows Wy [Maat - yd - 29 Vl - SAMPLE INFORMATION: AREA (FT?] SURFACE MATERIAL wy a 1 LAB RESULT a LABORATORY # SAMPLE # LOCATION WOOD] METAL | BRICK | OTHER - = 9 H ~ eGL-L - Bees : Field Blam t v H el Q Q HO H a HOH U Oo ws 64 HoH nD Pp a an ~ fo) No ep) Fl 0] H No oO oO CO Q H re, TURNAROUND REQUIRED: COMMENTS / INSTRUCTIONS | : normarQ) stat ne wv / / 6 He TAT fe RELIMURISHED BY (SIGNATURE) DATE esl PRINTED NAME RECEIVED BY {SIGNATURE} DATE PRINTED NAME i" wit Qo | Maple M fepoe [ATC Lab /Posd) me oes! Kota’ ms mana BY (SKGNATURE one £9 02 PRINTED NAME RECEIVED BY LAB SIGNATURE) DATE PRINTED NAME S TEP Py cHn ee NO time [90 THAE No © WHITE - OFFICE / YETI LAR J ein. Coicair ~l NYC-WTC_000232916