NYC-WTC_000221483

NYC 9/11 Public Portal Document CITY_21MC100 002887872 Pace Analytical www.pacelabs.com Required Client Information: Repor To: sames Section B ohn Required Client Information: Section A Company ATC Associates Inc Copy To: Address "104 E 25th street Invoice To: Loth floor P.O. NewYork, NY 10010 Project Name: PS 89M 212.353.8280 212.353.8306 Projeci Numio 9125-0297 Section D Required Client Information: Valid Matrix Codes + MATRIX •CODE ITEM # 2 3 SAMPLE ID One character per box. (A-Z, 0-9/.-) Sample IDs MUST BE UNIQUE T 41781 18l 9M- ATC -04/8-89 AtC-0418- WATER SOIL WT OIL SL OL WIPE WP AIR TISSUE AR TS OTHER OT BA D DX 7 8 g SA 10 11 12 SHIPMENT METHOD Feder SAMPLE CONDITION Temp in °C Received on Ice AIRBILL NO. SHIPPING DATE ITEM NO. OF COOLERS NUTABER RELINQUISHED BY / AFFILIATION | DATE Sealed Cooler Samples Intact Additional Comments: : SAMPLE NOTES Dle uae the same Blast df150p with there sampls. ORIGINAL NYC-WTC_000221483 CHACOF CUSEODI Ancyticu Reyuust _ucuount The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. 625144 Page: of To Be Completed by Pace Analytical and Client Section C Quote Reference: Client Intormation (Check quote/contract): Requested Due Date: ITAT: • Turn around limes less than 14 days subjact to laboratory and contractual obligations and may result in a Aush Turnaround Surcharge. Turn Around Time (TAT) in calendar days. MATRIX CODE DATE COLLECTED м/а/y srat dot TIME COLLECTED alea NP 4/18/02 WP 4/12/02/mL NP4/18/02 ( m= Preservatives # Containers Project Manager: Project #: 1054603 Prolile #: Requested Analysis: ioxin Remarks / Lab li fost Fail Nortk 103481354 Vistpleor tal soute 103481362 floHaMSonth 16348131 AL TIME ACCEPTED BY / AFFILIATION DATE TIME Aasad 12302 -930 SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER: SIGNATURE OÍ SAMPLER: Wayci Wcpot CFE DEVEDCE CINE' ADNCTDIATIOAIO /DATE Signed: (MM/ DD / YY) 4/.18/02 Earm rorA Da.nro