NYC-WTC_000199049

NYC 9/11 Public Portal Document

rTi 13 I J L43HA^OIlc^)USOlD^, AnL.^lcl^i^e^^st^^cU*^infent^ / PaceAnalyticar Ths Chain-of-Custody la a LEGAL DOCUMENT. All relevant flelda must be completed accurately.

www.patalabs.cem Section B Required Client Intormation: fiefxrrt To: "k [Page: | of । | 625144 Required Client Information: Company Section A Vv\ To Be Completed by Pace Analytical and Client SSCtlon C Copy To: Quote Reference: ” Client information (Check quote/contract): Address invoice To: Requested Oue Dele: Project Manager:

* Turn around limes less than 14 days subject to Project»: /O^ </»^ laboratory and contractual obligallons and may result in a Project Name: Rush Turnaround Surcharge Profile »: yy Phone , /^/ I Fax Zd>o/0 Project Number: pF Turn Around Time (TAT) in calendar days. Requested Analysis:

Section 0 VaUd Matrix Codes A------------ - Rsquired Client Infoimalion'. s Preservatives

SAMPLE ID MATRIX WATER SOIL CODE VYT SL LU si e OIL WIPE OL WP § X s One character per box. AIR AR £ o e (A-Z,0-9/.-) Sample IDs MUST BE UNIQUE TISSUE OTHER TS OT i mm / dd / yy hRWWnf/p 1 Remarks / Lab IC

4 T1 c o 5 1 J I'll b 1 I I -S 2 4 r C- o 5 /& D idi 3 1/^ 4 ■

I 1 '0 f 5 '^4 i 6 •i 1 FT' 3^ a 1 I 7 Si 8 ■I 9 g a ft 10 i 1 I 11 12 I I o HIPMENT METHOD ACCEPIED BY / AFFILIATION H K I ho I SAMPLE CONDITION 1 SAMPLE NOTES s Temp in °C O o Received on Ice o Io Sealed Cooler o PRINT Nam. o( SAMPLER: co o Samples Intact j(yt co SIGNATURE o( SAMPLER: DATE Signed; (MM / DD / YY) o Additional Comments: co

ORiGINAt CCC DB^rcDOC C*irxc c*r>r» isiOTrM iz^Tfoair*

NYC-WTC_000199049