NYC-WTC_000221484

NYC 9/11 Public Portal Document

'"^Pace Analytical' CHAIN-6f-CUSTODY / Analytical Request Document The Chaln-of-Custody Is a LEGAL DOCUMENT. All relevant fields must be completed accurately. www.pacelatis.coni Required Client Information: Raport To: -» Section B \ I Page: | of^ 625144 Required Client Information: Section A _______ To Be Completed by Pace Analytical and Client Section C Copy To: Quote Reference: Client Information (Check quote/contract): Invoice To; Requested Oue Date: ‘TAT: Project Manager:

* Turn around times less than 14 days subject to Project #; laboratory and contractual obligations and may result in a ProiornName: Rush Turnaround Surcharge. Prollle#: Turn Around Uma (TAT) in calendar days. Phone Fax Requeitad Aiulytls: :=zLi-uLyL-i2s±. Section D Required Client Information: Valid Matrix Codes - ------------- o Preservatives MATRIX CODE u WATER g ISS e SAMPLE ID SOIL OIL & 8 18 0 § 9’ / % n 8 I WIPE s One character per box. AIR r ar" K o £ d (A-Z.0-9/.-) c CM § o ex co t Sample IDs MUST BE UNIQUE TISSUE OTHER g 5 mm/dd/yy 1^4 O X T X z Remarks / Lab ID

r o 87 g Kx ■SI/ i ft EO T c. G 1 'IB s I I< fl iW -ixl 1= 1^1 1^1 h- SI I <9 I (4t 1 s i w 1 w 6 i i_ i B I 5 B s i I i I B i i s I I Si # Is I 1= 88 fW

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1 s i I s a i fi ■ i i 1 Mt 1 o i SHIPMENT METHOD I AIRBILL NO. SHIPPING DATE NO. OF COOLERS RELINQUISHED ACCEPTED BY/AFFILIATION DATE TIME H -20 to SAMPLE CONDITION SAMPLE NOTES s o o Temp in °C b- 6-. 4^ o Received on Ice I SAMPLER NAME AND SIGNATURE o Sealed Cooler o PRINT Name of SAMPLER: CO Samples Intact >>1 CO SIGNATURE ol SAMPLER: DATE Signed; (MM / DD / YY) CO Additional Comments: co

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NYC-WTC_000221484