Chain-of-custody form for dust samples

NYC 9/11 Public Portal Document val Mtoe toy fob bod tad toa tSHADOR DUSTODY.. Anw stick: Regusst Scuin2dnt } . PA ce Ana yti ca {” The Chain-of-Custody Is a LEGAL DOCUMENT. All relevant fields must be completed accurately. , www.pacelabs. Required Cent Inf ion: Section B s.com saute ‘ow, C, =~ [Pa °: f | . 625144 Required Client Information: Section A =~ \AWS \ MM ge: { ° J To Be Completed by Pace Analytical and Client Section C [Company AT Cc A . _ Copy To: : Quote Reference: a3 Xe) Crola Inc. ‘ Client information (Check quote/contract): Address Invoice To: Requested Date: *TAT: |Project Mai lok East. Shrew | rj Mansoor ; P.O. * Tum around . Project #: (0 th Sloor P so yan canna cpt cramay routing | L2 SB0EE rojact Name: . : o~ W/ ew DoVks, y NY oolo PS 150M Tum Around Time (TAT) in calendar days. Protie# Phone Fax Project Number. Re ted Analysis: 0 ia we hall /F1AS-OAF4 | aa ta Section D Required Client Information: MATRON Codes oor TN 9 a Preservatives WATER wr w Wo wo c SAMPLE 1D Sol st 9 a3 - AE |. = = One character par box. we . an 3 9 a ¢ lel |x a ra nT} (A-Z, 0-9 / —) TISSUE TS 3 8 10 | 3 3iSi% 4 md Sample IDs MUST BE UNIQUE OTHER OT mm/dd/yy yates, «(SI2/Z/z/2/2 Remarks / Lab IC 3 Alrlc|-lols |al8|-frislomisio lx ite] Belwe|se/n| / m LZS7YRS ea Ay a Aa - - H oO M : no H & x <q Fl ™ HoH ie) > Oo fF Le D4 . ate G4 - HoH E : a ~ , bs f nh oO O 8 | i s 3 ee ml y abe la) Oo ) ray DA lee) Q Fed! + a UE 4 SAMPLE CONDITION SAMPLE NOTES Lo | Temp in °C a hb | Received on ice | YA) - SALIPLER NALIE AND SIGNATURE © |Sealed Cooler ¢y/N PRINT Name of SAMPLER: V7 = lo Samples Intact /N SIGNATURE ot SAMPLER th GD. UU al 3 Signad: VY} Additional Comments: — eat oar amano o Ae evr N ORIGINAL CEE MPEVCOCE CINE TAR IO TNNATIANAIn Bore COCNt Qa Aen Oo NYC-WTC_000178046