NYC-WTC_000223532

NYC 9/11 Public Portal Document

CHAIN-OF-CUSTODY / Analytical Request Document 1700 Elm St., Suite 200 The Chain-of-Cuslody is a LEGAL DOCUMENT. All reievant fields must be completed accurately ^aceAnatytica/' Minneapolis, MN 55414 CO/ri (612) 607-1700 |Page: \ of I 1 fRequired Client Information: Section A Required Clienl Information: Section B Client Information (Check quote/contract): To Be Completed by Pace Analytical Client: Section C Report To: Requested Due Dale: Quote Reference:

Copy To: *TAT: Project Manager:

Invoice To: * Turn around times less than 14 days subject Project #;

Phone: Pax: P.O. laboratory and contractual obligations and may Profile a.

pectName: in a Rush Turnaround Surcharge,

Project Number: Turn Around Time (TAT) in calender days.

Required Client information: Section D Vaiid M/yg Cade, V ZB) Preservatives Requested Analysis Q

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s o SAMPLE CONDITION:

Temp in C SAMPLE NOTES:

o I Received on Ice Y/N o o ro Sealed Cooler Y/N SAMPLER NAME AND SIGNATURE co Sample Intact Y/N I PRINT Name of SAMPLER:

Additional Comments: SIGNATURE of SAMPLER DATE Signed;

NYC-WTC_000223532