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CHAIN-OF-CUSTODY / Analytical Request uocument <br /> ;aceAnali4ical The Chaln-of-Custody is a LEGAL DOCUMENT All relevant fields must be completed accurately <br /> 579894 <br /> ' Section A R Section B Page• of To Be Completed by Pace Analytical and Client Section C <br /> Required Client information Required Client Information <br /> Company ` Report To 1 Quote Reference <br /> 19l ` �/ � Ql vi Client information Check uotelcontract <br /> AddressZ.12 Invoice To Requested Due Date TALProject Manager <br /> i ,,y P 18-fl <br /> {fit O +Tum around times less than 14 days subject to Project# <br /> CA (J� J Q T (t laboratory and contractual obligations and may result in a <br /> Pro act Name FRush Tumaround Surcharge Profile# <br /> Tum Around Time(TAT)in calendar days <br /> P-1119/ <br /> Phone I Fax ProA0 Number Requested Analysis <br /> Section D Required Client Information Valid <br /> Matrix Codes 4IX w w Preservatives <br /> WATER WT 0 F V w U <br /> SAMPLE I D solL sL O a_J1 � v T- <br /> OIL OL U O- �-J m <br /> One character per box AER E pR O 0 it N o M = lli <br /> w (A—Z,0-91 —) TISSUE TS Q U c �Z U Oro ce rV <br /> F Sample IDs MUST BE UNIQUE OTHER OT mm 1 dd 1 yy hh mm alp Z) 12 = z z q Remarks Lab ID <br /> +�/ <br /> 1 d, <br /> `/l fv k qqq SL. <br /> 12-110/0 101 <br /> 5�5}� e�■ <br /> 4wA 3 YaSr.1'�s` +4f SY <br /> w „± 1 ,r.V <br /> 5 <br /> x <br /> r � , <br /> 4 � � —71 <br /> L� �A <br /> ) <br /> M o x -.' /wry N <br /> wad A , ? 15D _ <br /> n <br /> IR <br /> Notes I Accepted By company <br /> Temp In°C <br /> Received on ICE Y 1 N D <br /> Sealed Cooler Y 1 N <br /> Samples Intact Y 1 N <br /> Additional Comments <br /> PRI Nameof ` PLEA <br /> 3f/)J7/� D�G1A 1 .7 tit/1 <br /> SIGNATURE of SAMP DATE Signed {�rx i DD i rr� <br /> lets IZ 1 <br /> SEE REVERSE SID& INSTRUCTIONS Pace/ Services Inc C0001 02100 <br /> no ifl-t Ai AI <br />