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CHAIN-OF-CUSTODY I AnaByt cal Request Document
/ eAnalytical° The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields must be completed accurately.- O
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Section A Section B Section C I,
Required Client Information: Required Project Information Invoice Information 1. 806456
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��i o�ne. e' ax. Project Name: Pana Project Site Location
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equesrted Due DateffAT: 'Project Number: Paco Profile ASTATE: —
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Section D Matrix Codes Z
RequlrodClionl Information MATRIX I CODE c COLLECTED Preservatives r > t.
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ADDITIONAL COMMENTS RELINQUISHED BY I AFFILIATION L: 0^�T� ACCEPTED BY I AFFILIATION DATE TIME I SAMPLE CONDITIONS
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SAMPLER NAME AND SIGNATURE U o o m
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ORIGINAL PRINT Name of SAMPLER: e '.;•(-e_.4-- l v .5 CI m 0 m i nDATE Signed `— rJ mESIGNATURE of SAMPL : —�f V :/p/4„:),\27 ,,,ka ._-\--
(MM/DD/YY):
'Important Note.By signing this form you are accepting Pace's NET 30 day payment terms and agreeing to Into charges of 1 5%par month for any Invokes not paid within 30 days F-ALL-Q-020rev 07,15-May-2007