NYC-WTC_000203439

NYC 9/11 Public Portal Document 3 4 5 8 10 11 CITY 21MC100 003068183 CHAIN-OF-CUSTODY I Analytical Request Document Pace Analytical™ www.pacelads.com The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Required Client Information: Section B Freport To: 611675 Required Client information: Section A James Cohn Page: \ To Be Completed by Pace Analytical and Client Section C Company ATC Associater Fnc Copy To: Quote Relererice: Address "104 E 25th street Invoice To: Client Information (Check quote/contract): Requested Due Date: TAT: Project Manager: loth floor P.O. Newyork NY 100/0 Fax • Turn around times less than 14 days subject to laboratory and contractual obligations and may result in a Rush Turnaround Surcharge. Turn Around Tirne (TAT) in calendar days. Project #: Profile #: 1055250 Phone Requested Anatysis: 212.353.8280 212.353.8306 Section D Required Client Information: Preservatives ITEM # 1 2 Project Name: PS 150M Project Number. 19125-0289 Valid Matrix Codes + MATRIX WATER CODE WT SAMPLE ID SOIL SL OIL WIPE OL WP One character per box. L AIR AR (A-Z, 0-9/.-) TISSUE TS Sample IDs MUST BE UNIQUE OTHER OT ATC-03 15-/5°M-Dixi ATC-03/5-1 5OM- DIX2 MATRIX CODE DATE COLLECTED TIME COLLECTED area mm / dd / yy hh:mm alp WP 3/15/02 Im2 wир 3/15/02 B1Д4К # Containers Unpreserved H,SO, HNO, HCI NaOH Na,S,O, Methanol Other Di'oxin Remarks / Lab ID Main Lobby Jlar 3398996 Blauk 3399007 12 SHIPMENT METHOD Fedey SAMPLE CONDITION Temp in °C AIRBILL NO. SHIPPING DATE NO: OF COOLERS HUMBER RELINQUISHED BY / AFFILIATION DATE TIME 3/18/02. ACCEPTED 3Y / AFFILIATION DATE! TIME: 1/72 1020 Received on Ice Sealed Cooler SAMPLE NOTES pls. include the blank with all the saupor por The other school SAMPLER NAME AND SIGNATURE PAINT Name ot SAMPLER: WAGDI Samples Intact, Ardit'-nal C---ents: RATE Sina, /NA.JiDYYY. NYC-WTC_000203439