NYC-WTC_000219415

NYC 9/11 Public Portal Document

CHAIN-OF-CUSTODY / Analytical Request Document wAnalyticar The Chain-cf-Cuatody la a LEGAL DOCUMENT All relevant fields must be completed accurately.

iLquiI WWW.pK^rtBO* Raqulred Clienl InlofmaliCTi: FtafXxtTo: —■"T J" Section B [page; t of I G23392 Ired Client Informatton: Section A 2> ;VI\ To Be Comptelod by Pace AneriyUcai and CHont SeCtiOn C Quota Rotarancs: Cgent Wonwattoo (Ch^ck quoteZcontracty. Invoice To: npry WirtOrt Duo Dnfa nAT Pra^ct Uttiager /ij/y P.O. * Turn around Ibnas leas than 14 days sufajact to Proioct»: taborakwy and contractual obttoations and may result In a Hush TumafDund Suichaiga. ProSo#: Vs. Turn Around Tww (TAT) in calendar days. Phone I Fax PtaMNun^^^ ^

Section D Required Clieol formation; Valid Maw* Codas-<---------- _ o PreservatiifM

SAMPLE ID MATRa WATER SOH. CODE wr st tu

§ 2 i * s g One character per box. (A-Z.0-9/.-) Sample IDs MUST BE UNIQUE OIL WIPE AIR TISSUE OTHER . OL WP AH TS OT X £C o

i mm/dd/yy hhln^‘ a/p & i 15 Ilk. 3 Remarks / Lab ID

ZHUBiBBBiBgD^<B>^BF$H»IIH ragnuniirasB^BiKsisgra sHgiaHHfiB^BBaSHSHgBSjipMBMmHIIHIHHgBlBMBB 4BaaiSBgH9BgnfiH^B^BSB«IIHHmBIIIIIIIIIHigB»B!BBB iBaaaBiHiaHninHHiiHBnnsraiiiiiiiiiBES^HHflHBB

miliilgH 6 7 8 !Ri« 9 10 11 BiBBBiB/IBaaSBeB^H^BSBIBHBHIIIIIIIIIB&BiBBHHBB ■■iiiiHHininia O

H 12 BaU^BiBiB^BiBSISBlBHHHIIIIIIIIIBifliBIIBHBB SHIPMENT METHOD I AIRBILL NO. SHIPPING DATE NO. OF COOLERS!,jJmr RELINQUISHED BY / AFFILIATION DATE TIME ACCEPTED DY / AFFILIATION j DATE TIME k: I I r>Z fcy SAMPLE CONDITION J____ SAMPLE NOTES I o Temp in °C o I Received on Ice Y/N o o SAMPLER NAME AND SIGNATURE Sealed Cooler Y/N CO PRINT Name of SAMPLER: CO O Samples Intact Y/N M SIGNATURE ol SAMPLER: DATE Signed; (MM / DO / YY) Additional Comments: CO

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NYC-WTC_000219415