Chain-of-custody form for analytical request

z Z CHAIN-OF-CUSTODY / Analytical Request Document ■<

o o The Chain-of-Custody Is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Analytical" co

s www.pac8labs.com Required Client information: Section B 611675 '2 Report To; “0 Required Ciier.i Information; Section A Page: | of ( ] To Be Completed by Pace Analyticed and Client SCCtiOH C c CT o Company Cooy To: Quote Reference: o KtfoCAdagLa o' Client Information (Check quote/contract): Address invoice To: Requested Oue Date: I’TAT: Proiect Manager: "0 CO o O 03 4^ P.O. Project #: ro Tk • Turn around times less Ilian 14 days subject to laboratory and contractual obligations and may result in a 5'6 ^2^ 0 Rush Turnaround Surcharge. o . ZZ/ fOoTb Turn Around Time (TAT) in calendar days. Profile «; o c Phone Fax Project Number: Requested Analysis: 3 IS?. ____ IHI / / / / o z Section D Required Client Information: Valid Matrix Q Q Preservatives CO MATRIX LU UJ G WATER UJ Q CO o G SAMPLE ID SOIL SL\ 8 u? •o 0) o M OIL OL “d .= e o’ o O One character per box. WIPE WP X o u 2 S H S (A-Z, 0-9 /.-) AIR AR c o l°’s o 2 1 s I OJ

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S.^MPLE CONDITION 1 1 Li SAMPLE NOTES Temp in ’C o o Received on Ice I o SAMPLER NAME AND SIGNATURE o Sealed Cooler yT? PRINT Name a( SAMPLER: CT Samples Intact o Additional Comments; Signature oi sampler: 5557’ I DATE Siqneo- (MM DD'YY;

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