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NYC-WTC_000219421

Label derived from the City's folder field. The City does not supply document titles.NYC-WTC_000219421–000219425
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Scanned page image, NYC-WTC_000219421
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NYC 9/11 Public Portal Document Pace Analytical™ ww.pacelabs.com Required Cliont Information: Section B Report To: James Ceha Requirad Clent Information: Section A Company ATC Associatas Ine Address 104 É 251h Street 10Th floor Capy тo: CHAIN-OF-CUSTODY I Analytical Request Document The Chain-ot-Cusiody is a LEGAL DOCUMENT. All relevant fiolds must be completed accurately. 625143 Page: | of | To Be Complated by Pace Anatylical and Cliert Section C ¡Quota Peference: inroice To: P.O. Phone 212.353.8280 Section D Fax 212-353-8305 Proquirad Cliont Information: SAMPLEID ITEM # One character per box. (A-Z,0-9/-) Sample IDs MUST BE UNIQUE Project Nama: 519125-0297 Projact Number. PS 89M Valld Matrix Codes 4 MATRIX CODE WATER WT SOIL OIL SL WIPE OL WР AIR TISSUE AR TS OTHER OT A A A 2 9 9 X C X Chent Information (Check quote/contract): Requestad Due Date:: "TAT: * Tum around timae lesa than 14 days auciect to laborstary and corractual obligations and may rosult in a Hush Tumaround Surcharge, Turm Around Time (TAT) in celender days. MATRIX CODE DATE COLLECTED mm/ dd / yy WP d1l25/o2 TIME COLLECTED Preservatives ers red 1 M32 Im? B/aIK Project Manager: Projoct #: Profile #: ad Anatysis: loXin V el Remarks / Lab ID 194 Ahrth CITY_21MC100_ 002880338 5 7 8 10 11 12 SHIPMENT METHOD Fed ev SAMPLE CONDITION Temp in °C Received on Ice |Y/N Sealed Cooler Y/N Y/N Samples Intact Additional Comments: NYC-WTC_000219421 AIRBILL NO. SAMPLE NOTES SHIPPING DATE NO. OF COOLERS ITEM ANULBER! RELINOUISHED BY / AFFILIATION DATE 1/28|02 TIME ACCEPTED BY / AFFILIATION DATE TIME SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER: IVAGOT SIGNATURE of SAMPLER: Hiagoti. meraalrmoprarpn dpt ppaaa DATE Signed: (MAM/DD / YY) Form COCO1 Rev 0601

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NYC-WTC_000219421Source: NYC Law Department, mirrored locally

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