NYC-WTC_000224774

NYC 9/11 Public Portal Document 1... l.: .: / 4 5 6 7 8 9 10 11 12 CITY 21MC100 002894532 Pace Analytical™ www.pocoloos.com Requirad Client Information: Sectlon A Company ATC Associatos Inc Addross 104 E 2512 stwat 10Th floor NewYorke 100/0 Phona Fax 262/353-8280 212.. $53-8306 Section D Roquired Client Information: Il-d %SHANORJUSTJDY, Anbryticar Requdst bdcubrenti The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must ha compleled accurately. Requlred Client Information: Section 8 Report To: Jamas Cahn 625144 Page: ! ofi To Be Completed by Pace Analytical and Client Section C Copy To: Quote Reference: Invoice To: Client Information (Check quote/contract): Raquesled Dua Date: TAT: Project Manager: P.O. Project o: 1058095 ITEM # Project Name: PS.I5OM Project Number: 19125-0989 Valid Matrix Codes +- MATRIX CODE WATER WT SAMPLEID SOIL SL OIL OL WIPE WP One character per box. AIR AR (A-Z, 0-9/.-) TISSUE TS Sample IDs MUST BE UNIQUE QTHER OL T 5/ F5o EX 4TE-•513 115 CM 50 72 * Turn around times leas than 14 days subject to laboratory and contractuel obligations and may. result in a Rush Tumaround Surcharge. Turn Around Time (TAT) in calendar days. Profile #: Roquootod Anolyolo: MATRIX CODE DATE COLLECTED mm / dd / yy WP 5/13/02 SWP 5/13/02 TIME COLLECTED Proservativas # Containers H2SO, HNO, HCI NaOH Other 1a92 1 mp8 Йаiм foaby Blank Remarks / Lab i 358004 SHIPMENT METHOD Fedey SAMPLE CONDITION Temp in °C Received on Ice Sealed Cooler Samples Intact CJN Additional Comments: AIRBILL NO. SHIPPING DATE INO. OF COOLERS IEM NUIIBER RELINQUISHED BY / AFFILIATION DATE | TIME SAMPLE NOTES ACCEPTED BY / AFFILIATION K-Band DATE TIME Faa/oo11i5 ORIGINAL SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER: WAGDE рsотиne « 5re Alyad CEE DEVEDCE AIAA FAM DATE Signed: (MM / DD / YY) NYC-WTC_000224774