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CHAIN-OF-CUSTODY ! Analytical Request Document <br /> WaceAnalyfical The Chaln-of-Custody is a LEGAL DOCUMENT All relevant fields must be completed accurately , <br /> -" 57989? <br /> Section A R Section S Page of To Be Completed b yl <br /> Required Client Information Required Client Information y Pace Analytical and Client Section C <br /> Company R port 7a Quota Reference <br /> i!1 �`J Client Information Checkquote/contract) <br /> Addresslis I voice To Requested Due Date TAyT Project Manager <br /> ✓` <br /> JJ <br /> PO t Tum around times less than 14 days subject to Project <br /> J 1 laboratory and contractual obligations and may result in a <br /> 13:10lect Name Rush Turnaround Surcharge Profile# <br /> ct I Tum Around Time(TAT)in calendar days <br /> Phone FaxP ect Number Requested Analysis <br /> Section D Required Client Information Valid Matnx Codes O Q Preservatives <br /> MATRIX CODE w w <br /> WATER WT UJ <br /> SAMPLE ID H U w U n <br /> SOIL SL ¢w w <br /> OIL OL 0 o-.1 F- <br /> k WIPE WP X 0 0 a d <br /> One character per box AIR ARm U v o O O_ O _ <br /> W (A-Z,0-91 -} TISSUE TS Q v c �z v Zaro <br /> H Sample IDS MUST BE UNIQUE OTHER OT ` mmddyy hh�7MMA/1alp _ _ = Z Z Remarks/Lab ID <br /> $YY ar Y Ifff i1 <br /> kny <br /> m % Iws4'1 FAM � 3T FAL' <br /> t s� Aac � i ✓`�N k '� <br /> .3 L ,t <br /> la <br /> ' r <br /> ,`"r k '01 N <br /> �'y� <br /> 1•.� " .� z � ` `� i '' c !`MVV "� .' <br /> M �:.r 1 <br /> 1 �[✓ «i V <br /> j � V (� <br /> Arg n, <br /> g a <br /> i�x{ �- a <br /> M2ZLl q2- <br /> y 'f N V D <br /> . . . . . . . . . . . . <br /> Temp to°C V H <br /> Received on ICE Y N <br /> Sealed Cooler N <br /> Samples Intact Y• N <br /> Additional Comments <br /> y — P Name Q PLER <br /> SI RE of DATE Signed (MM/DD/M ^` <br /> • SEE REVERSE SIDI& INSTRUCTIONS Pace Analytical Services Ac WC0001 02100 <br /> ORIGINAL <br />