NYC-WTC_000211845

NYC 9/11 Public Portal Document uMAiiM-ur-uub I uuY / Analytical Kequest Document Analytical'' The Chain~of~Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately.

iTOw.pacelahs.cQm Required Client Information: SSCtjon B Report To: 7~] F 625143 lequlred Client Information: Section A _____ Fq Copy To; I Page: 1 1 | To Be Compleled by Pace Analytical and Client SeCtlon C

.ddress -Woaafc Client Information (Check quote/contract): Quote Reference:

Invoice To: Requested Due.Data: (Q TAT; Project Manager:

P.O. * Turn around times less than 14 days subject to Project #: laboratory and contractual obligations and may result tn a Project Name: Rush Turnaround Surcharge. Profile #: Turn Around Time (TAT) In calendar days. 'hone Fax Project Number: Requested Analysis:

Section D Required Clierl Inlormalion: Valid Matrix Codes ◄-------- MATRIX CODE Q o Preservatives in WATER WT lU

41: S SAMPLE ID One character per box. SOIL OIL WIPE z Q O O X k uj Ci d o o . Rd o o (/) ID C .2 <v £ o w o"n oc ;ol7 5 AtR tc c X ro UI (A-Z, 0-9 /.-) o o o W«v .c 0) TISSUE O c wPJ z o o Cd rd 0) x: SampleTDs MUST BE UNIQUE OTHER s mm / dd / yy St D X X X z Z 5 6 / Lab ID

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to _____ I 1 (—1 SAMPLE CONDITION SAMPLE NOTES S Temp in °C O 42_ o Received on Ice Y/<^ o I o Sealed Cooler y/6p SAryiPLERtJAMEANDSIGNATURE PRINT Name of SAMPLER: Samples Intact ^/N (JI (JI (JI Additional Comments: SIGNATURE of SAMPLER: DATE Signed: (MM / DD / YY) (JI

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NYC-WTC_000211845