Chain of custody form for analytical request document

NYC 9/11 Public Portal Document

i I ! i I CHAIN-OF-CUSTODY / Analytical Request Document ,/^^ceAnafyticar (612) 607-1700 The Chairt-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately

1700 Elm St., Suite 20 Minneapolis, MN 55414 |Page: / of / 1 'Required Client Information; Section A Required Client Information: SeCtlOD B Client Information (Check quote/contract): To Be Completed by Pacs Analytical Client: Section C Requested Due Date: Company; /? < Report To; —1“ C < A .n Quote Reference:

Address: Copy To: ■TAT: Project Manager;

Invoice To: Az ///’- '■ r

£. L P.O. * Turn around times less than 14 days subject

laboratory and contractual obligations and may Projecl #:

Profile tl. / o Project Name. r •) j in a Rush Turnaround Surcharge.

w Project Number: ; t Turn Around Time (TAT) in calender days.

co Required Client Information: Section D Valid Mar-ji CM»» Preservatives G Requested Analysis

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