NYC-WTC_000229569

NYC 9/11 Public Portal Document

/^PaceAnalyticar CHAIN-OF-CUSTODY / Analytical Request Document The Cha!n-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately.

www.pacelabt.cam Required Client Information: Report To: y Section B 7 Page: | of | 625144 Required Client Information: Section A To Be Completed by Pace Analytical and Client Section C Company Copy To: Quote Reference; 4Tc. Client Information (Check quote/contract): Address Invoice to: Requested Due Date; *TAT; Project Manager;

P.O. * Turn around times less than 14 days subject to /'o fZ. (^r422i^r^ Project Name; laboratory and contractual obligations and may result in a Rush Turnaround Surcharge, ^7/9 Profile #: Turn Around Time (TAT) in calendar days. Phone Fax PrCeCNumLe^ Requested Anelyeie:

Section D Required Client Information: Valid Matrix Codes <-------- —, Q Q Preservatives MATRIX CODE LU LU WATER WT

* SAMPLE I D SOIL OIL SL OL Q O O ii8 s§ .1 § CQ o

I s wo WIPE WP X c One character per box. AR o ca S ID t- (A-Z, 0-9 / Sample IDs MUST BE UNIQUE AIR TISSUE OTHER TS OT I2 mm / dd / yy D Q. C o z o £I I 5 o I cy to Z I s / Remarks / Lab IC

3 4 5 iraiiaisi8igiai‘ ■HliEIHIHKBim IHHIIM/SlililJIi

■ina 6 7 8 HO !S|

9 10 ha ■st Ml— 11 a O 12 SHIPMENT METHOD AIRBILL NO. ft'®

ITEM SHIPPING DATE NO. OF COOLERS NUMBER RELINQUISHED BY / AFFILIATION inHiipiifSfl^BBigis DATE TIME I ACCEPTED BY/AFFILIATION DATE H

SAMPLE CONDITION SAMPLE NOTES a f Temp in °C O O Io Received on Ice Yy<3> ■ /</? o SAMPLER NAME AND SIGNATURE Sealed Cooler PRINT Name of SAMPLER: O CO Samples Intact SIGNATURE of SAMPLER: DATE Signed: (MM / DD / VY) CO Additional Comments: I jf, . CO

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NYC-WTC_000229569