NYC-WTC_000223172

NYC 9/11 Public Portal Document

CHAIN-OF-CUSTODY / Analytical Request Document PaceAnalyticar The Chain-of-Custody fs a LEGAL DOCUMENT, AH reiavant fields must ba campfatad accurataly.

www.paulabi.com Requlwd Client Intowwation: Report To: (2o\au Section B [Page: I of t 625144 Requited Clienl Intwmation: Section A To Ba Completed by Pace Analytical and Clienl Section C Copy To: Quote Reference: Alc Invoice To: Clienl Inlotmalion (Check quola/conlfacl): naquaslad Oue Oale; Tat ProlocI Manager:

P.O la*^ .^t Q C Z" Protect Name: - Turn around times less than H days subfect to laboratory and oonuactuat obligations and may rasuM in a Rush Turnaround Surcharge. Pioiecl «:

Profile «. \a5Uuo\ Phone A// Project Number pg ,^3^^ Turn Around Tima (TAT) in calerxlar days. Rsquefitad Analysis ;.;n g3o£ Section D Required Client Informalion; Valid Matrix Codes ------------ Q o Preservatives MATRIX COPE LU UJ WATER WT LU 1^0 SOIL Q SAMPLE ID OIL SL OL 8 oo I 2 One character per box. WIPE AIR WP AR X CE 8 2 8’ oZ 1 are4 o I" 1 § I (O LU (A-Z. 0-9 / TISSUE TS oI (0* I Sample IDs MUST BE UNIQUE OTHER OT 2 mm / dd / yy w £ z 2 Remarks / Lab ID

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SHIPMENT METHOD AIRBILL NO I cuiooiwn piatc Lia nc rnoi cocl I™ I oci O SHIPPING DATE NO. OF COOLERSj '^1 RELINQUISHED BY/AFFILIATION DATE TIME ACCEPTED BY / AFFILIATION DATE TIME

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o Temp in °C 12- Received on Ice SAMPLER NAME AND SIGNATURE Sealed Cooler print Nams of SAMPtER

Samples Intact SIGNATURE of SAMPLER: I DATE Signed (MM Z DO / YY) Additional Comments: /.L o (). JAI CiPP PDC nic I IMO* •T'lr^ ('V'rrr* -

NYC-WTC_000223172