NYC-WTC_000202561

NYC 9/11 Public Portal Document

i ' C^AIh' QF-C''ST^^Y ' *na';‘-ca”^0qf *Tt r"Zur"-Tit The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Pace Analytical ' www.pacelabs.cuni Required Clier.t Itifortnation Report To; Section B (page: ( of ( 647712 Required Client information: Section A /Ta>7 To Be Corripleted by Pace Analytical and Client Section C Company Copy To; Quote Reference: g- <a-<y) V Client Information (Check quole/contractj: Requested Due Date; ’’TAT Address Invoice To: Project Manager:

P.O. * turn around times less man I4 days subject to laboratory and contractual obligations and may result in a Project Name; Rush Turnaround Surcharge. Profile #: Turn Around Time (TAT) in caletidar days. Project Number; Requested Analysis: / / / / ■ y Phone y<7y2r-d>2-9:^ / / / / / Section D Required Client Information; Valid Matrix Codes ------------------ Q Q Preservatives MATRIX CODE LU UJ WATER SOIL WT SL in Q ji' 5 o ? ID >2o •D SAMPLE ID OIL OL O O Q Zj /

4f/T777/7/ WP • O o o o ".2c c T 9. One character per box. o C/3 o' LU fc (A-Z, 0-9 /.-) Sample IDs MUST BE UNIQUE AIR TISSUE OTHER AR TS OT CE 5 2 mm / dd / yy Z’/x) hh:mm a/p Q c I (7) o CD O co x: z O « co TP D T z T Z 2 fl TO

s S'.. / 7 / / / / / / / / Remarks / Lab ID

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D 1 I I ;1 r K> - SHIPMENT METHOD AIRBILL NO. [SHIPPING DATE NO. OF COOLERS IK RELINQUISHED BY / AFFILIATION DATE ACCEPTED BY / AFFILIATION

s SAMPLE CONDITION I - - 79^^! ^/Wo SAMPLE NOTES / ' z I L I O: : Temp in “C 5b Received on Ice Y/® NJ SAMPLER NAME AND SIGNATURE Sealed Cooler Y/fi) ™-r.ameo,SAMPUeBL /J A/ 1'0 /M J

NYC-WTC_000202561