NYC-WTC_000196535

NYC 9/11 Public Portal Document • - -1 ■ :

i I { i i I CHAIN-OF-GUSTODY Z Anaiyticai Request Document The Chain-of-Custody is a LEGAL DOCUMENr. All relevant fields must be completed accurately. www.pacelabs.cam Required Client Information: Section B Required Client Information: Section A Report To; [Page: I of j 611675 Company To Be Completed by Pace Analytical and Client SoCtion C Copy To: ATC KsfocCoXi Jpwg-. Cjient Information (Check quote/contract): Quote Reference; ——— Address - Invoice To: Requested Due Date: *TAT; loth Project Manager:

P.O. to tv cf-Uvr- * Turn around times less than 14 days subject to laboratory and contractual obiigations and may result in a Project #;

Project Name; Rush Turnaround Surcharge. Profile #: —- ------------- / Turn Around lime (TAT) in calendar days. Phone Fax Project Number. __ t^v A5'-^oj27-f Requested Analysis: / / Section D Required Client Information; Valid Matrix Codes ◄——,

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i^SAIWLE CONDITION O----------------------------- ----------- SAMPLE NOTES *7:3c> -Tempin^C n p La) Received on Ice O Sealed Cooler Y/0) SAMPLER NAME AND SIGNATURE Ui PRINT Name of SAMPLER; -J Samples Intact 9/n Additional Comments: SIGNATURE of SAMPLER: I DATE Signed; (MwT- DD / YY)

NYC-WTC_000196535