NYC-WTC_000227083

NYC 9/11 Public Portal Document Pace Analytical www.pesecs.com Required Client Information: Section A compa A Te Associales Ihe Address 104E25th strat 1oth floor Newyork NY 100/0 Phone 212.353.8280 212.353.8306 Section D Requlred Client Information: ITEM # A 2 3 SAMPLE ID One character per box. (A-Z, 0-9/.-) Sample IDs MUST BE UNIQUE 3 3 3 8 3 853 5 6 7 8 9 10 11 12 89Í86800 ÍI SHIPMENT METHOD Fedex SAMPLE CONDITION Temp in °C Received on Ice Sealed Cooler Samples Intact On Additional Comments: ORIGINAL NYC-WTC_000227083 Required Client Information: Section B Report To: Janes Cohm Copy To: LnAIN-Ur-LuS uyY ! 4naIvyca' нeqrast I'ncumont ine chain-or-custody 15 f'LEGAL DUCUMENT. "Àll relevant fields must be completed accurately 625144 Page: To Be Completed by Pace Anatytical and Client Section C Quote Reference: Invoice To: P.O Project Name: M833 Project Numbe 1925-024 Valid Matrix Codes 4 MATRIX WATER CODE WT SOIL SL OIL WIPE OL WP AIR AR TISSUE TS OTHER OT D D Client information (Check quote/contract): Requested Due Date: TAT: Projact Manager: * Turn around timea less than 14 days subject to laboratory and contractual obligations and may result in a Rush Tumaround Surcharge. Tum Around Time (TAT) in calendar days. Projact #: 1055822 Profile #: Requested Analysis: Preservatives MATRIX CODE DATE COLLECTED TIME COLLECTED # Containers mm / dd / yy WP3/30/02 NP /m° Mi ista to Remarks / Lab | 10343550; j 512 AIRBILL NO. ITEM SHIPPING DATE NO. OF COOLERS TUAIBER RELINQUISHED BY / AFFILIATION| DATE TIME SAMPLE NOTES ps.use Rsane Blauk JISOM fu this sapls SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER: WABDI SIGNATURE of SAMPLER: Hhogat SFF REVERCE CINE EAD INCTRIINTINNIC ACCEPTED PV| AFFILIATION DATE, TIME $2/02100 TDATE Signed: (MM/DD/YY) Frrm Aocot Rer ne