NYC-WTC_000221480

NYC 9/11 Public Portal Document Pace Analytical www.pacalabs.com Required Client Information: Section A Company Address ATC Associates Inc 104 E 25th street 10th floor NewYork, NY 100/0 212.353.8280 212.353.8306 Section D Required Client Information: Reguired Client Information: Report To: ent Mames Cohn Section B Copy To: CHAIN-OF-CUSTODY TAnalytical Request Document The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. 611675 Page: of / To Be Completed by Pace Analytical and Client Section C Quote Reference: Invoice To: Client information (Check quote/contract): Aaquested Due Date: *TAT: Project Manager: P.O. * Tum around times less than 14 days subject to laboratory and contractual obligations and may result in a Rush Tumaround Surcharge. Turn Around Time (TAT) in calendar days. Project #: 1056.578 SAMPLEID ITEM# Project Name: PS 89M Propcumbo( 9125-0297 Valid Matrix Codes + MATRIX CODE WATER WT SOIL' OIL SL OL WIPE WP AIA AR TISSUE TS OTHER OT Profile #: Requested Analysis: One character per box. (A-Z, 0-9/.-) Sample IDs MUST BE UNIQUE ATC-04/1-89M-DXI ATC-0411-89M-DX2 ATC-04/1-89M-PX3 MATRIX CODE DATE COLLECTED TIME COLLECTED mm/dd / yy RRe9. WP 4/llla lml Preservatives Ietri HCI 2 NP /m2 ist flac Hall North V Ist flee thell soreth Jerdfloopal south Remarks / Lab IC 3468450 3468468 3468476 4 5 6 7 8 10 11 12 • SHIPMENT METHOD Fedex SAMPLE CONDITION Temp in °C 1152 Received on Ice Y/N AIRBILL NO. ITEM SHIPPING DATE NO: OF COOLERS NUMBER RELINQUISHED BY / AFFILIATION DATE | TIME ACCEPTED BY / AFFILIATIÓN DATE | TIME SAMPLE NOTES Sealed Cooler Y/N Samples Intact Y/N Additional Comments: pas base th same Black J150M, wilh Thi sapes Hase 9:40 rr.le a9 SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER: Wagehi SIGNATÜRE Of SAMPLER: TDATE Signed: (AM/DD/YY) ..la. NYC-WTC_000221480