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Pac6' An hitical CHAIN-OF-CUSTODY 1 Analytical Request Document <br /> The Chain-of Custody is a LEGAL DOCUMENT All relevant fields must be completed accurately <br /> The Right Clfenrutt y, The Rrgltl Svltrttutt'` <br /> 493717 !� <br /> Required Client information Section A Required Chant inlormalion Section B Page Of To Be Completed by Pace Analytical and Client Section `i <br /> Company ` ReportTo � Quote Aelerence <br /> ��V'A YJ Chenl Information Check uotelconlract <br /> Address Invoice To Requesle Due Dale TAT Project Manager <br /> S[.,1 S-}- G , n <br /> tL_ PO <br /> 1 Q •Under 14 day turnaround subject to laboratory and Poolect N 1 b <br /> { D {�V contractual obligations and may result in a Rush ` o <br /> Project Name 6 Turnaround Surcharge Profile M <br /> 1 Tum Afound Time{TAT)in calendar days <br /> Phone Fax Proj Number Requested Analysis <br /> 0 33 0 15 to ITI7a Sa-I <br /> Section D Required Cilenl Information Valid lrlatdx Codes f O Preservatives <br /> MATRIX CODE w F <br /> WATER WT d F U w U n <br /> SAMPLE ID SOIL sL o aJ �_j „ � <br /> OIL OL U d � ~ � c: <br /> WIPWP X O O m <br /> One character per box AIR E AR ¢ o - o x <br /> a � O - O <br /> (A-Z,0-91 -) TISSUE Ts a _ = z z Remarks I Lab ID <br /> Sample IDs MUST BE UNIQUE OTHER OT _ mm 1 dd 1 yy mm hh alp <br /> Ll <br /> W i <br /> ✓ r <br /> �i <br /> c I c <br /> W / Y ; <br /> V, • �� �I11f} fi�! .'rr C1 1[C <br /> IIItryi <br /> L'+ <br /> ►hit Io 4e.e <br /> a <br /> •�' � <br /> Ulf �� t €, 1s <br /> i <br /> Temp in°CAccepted By Company Date <br /> s <br /> Received on ICE Y / N <br /> Sealed Cooler Y / N <br /> Samples intact Y / N <br /> SAMPLER NAME AND SIGNATURE -------- <br /> Additional Comments <br /> PAIN Namm*SAIMAPLLH <br /> SIGN E !]AT€Sign 1 D01 YJ <br />