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aceAnalytical Field Services Division 3 BACK TO MAIN Pace Analytical Services, Inc. 1700 Elm Street, Suite 200 Minneapolis, MN 55414 Phone: 612.607.1700 Fax: 612.607.6444 3M Multi-city Food Study Project Date: December 4 - 8, 2000 Prepared by: Pace Analytical Services, Inc. Minnesota Field Services 1700 Elm Street, Suite 200 Minneapolis, MN 55414 Bradley G. Jacobson Project Manager Prepared under contract with: 3M ET&SS Field Analytical Services and Technologies Client Coordinator: Jess Eldridge 3M Lab Request: E00-2789 3M Department: 502180 Pace Project No.: 1039292 (Field) December 29, 2000 BACK TO MAIN Table of Contents Page Introduction 1 Field Sampling Methodologies 2 Table 1 Control City - Cleveland, TN 3 Table 2 Control City - Columbus, GA 4 Table 3 Control City - Port St. Lucie, FL 5 Table 4 Study City - Decatur, AL 6 Table 5 Study City - Mobile, AL 7 Table 6 Study City - Pensacola, FL 8 Table 7 Multi-city Food Study Freezer Log 9 Appendix A General Project Outline Appendix B Field Data Sheets Appendix C Chain of Custody Forms A-1 B-1 C-1 BACK TO MAIN Introduction Pace Analytical Services, Inc. was contracted by the 3M Company to collect representative food samples from three study cities and three control cities. The objective was to provide an estimation of the dietary intake of fluorochemicals (FC) by local residents. The study cities were represented by Pensacola, FL, Decatur, AL and Mobile, AL. The control cities were represented by Port St. Lucie, FL, Cleveland, TN and Columbus, GA. A two person sampling team visited three grocery stores within each city to purchase the following items: ground beef, pork, chicken, hot dogs, fish, eggs, milk, bread, green beans, apples and honey. Tables 1 - 6 summarize the data for each city, and deviations to obtaining the above items are noted in the comment section of each table. When available, food items were also obtained from farmers markets and organic grocery stores. Pace Analytical Page 1 BACK TO MAIN Sampling Methodology Sam ple C ontainers: New 1000 ml Nalgene sample containers were used for egg and milk samples. The containers were rinsed with laboratory grade methanol and Type I deionized (DI) water prior to use. All other food items were left in the original packaging and placed into zip-seal plastic bags. Sam ple H andling: Food items were handled in the same manner as a consumer would handle them. However, the technicians did wash their hands thoroughly prior to collecting the food items. Each food item was left in the original packaging and placed individually into zip-seal plastic bags, with the exception of the eggs and milk (or milk substitute). The eggs were cracked open and transferred to nalgene sample containers. The milk was also transferred from the original container to nalgene containers. Once the food items were properly contained, labeled and recorded on a chain of custody, they were stored in chest freezers and maintained at about minus 5C (refer to Table 7). Two freezers were used - one freezer was dedicated for the control city samples and the other for the study city samples. The exceptions to freezer storage were the apples and honey. These were stored in dedicated sample coolers. After the collection phase of the project was completed, the Pace sampling team delivered the samples directly to Centre Analytical on December 9, 2000. D eviations to the General Project O utline (GPO): The GPO specified collecting whole milk in a cardboard container. However, some of the stores only carried milk in plastic containers. In these cases, either the plastic container was purchased, and/or a substitute such as buttermilk or half-and-half cream was obtained if packaged in cardboard. The comments section on Tables 1 - 6 specify these variations. Pace Analytical Page 2 BACK TO MAIN Table 1 Control City - Cleveland, Tennessee S to re N am e: Bi - Lo General Comments: Located at: Keith Street, ju st north of 25th St. Date: 12/8/00 Nice clean store. Clientele appeared middle income. Located across from Tractor Supply Co. Sample Identification Bi-Lo Cleve Ground Beef Bi-Lo Cleve Pork Bi-Lo Cleve Chicken Bi-Lo Cleve Hot Dogs Bi-Lo Cleve Fish Bi-Lo Cleve Eggs Bi-Lo Cleve Milk Bi-Lo Cleve Bread Bi-Lo Cleve Green Beans Bi-Lo Cleve Apples Bi-Lo Cleve Honey Brand Name Bi-Lo Bi-Lo/Gold Star Bi-Lo Gold Star Charlie's Franks Bi-Lo Catfish Bi-Lo Mayfield Dairy Bi-Lo Bi-Lo/Harvest Choice Fuji Golding Farms Processed at In store/Mauldin, SC In store/Mauldin, SC In store/Mauldin, SC Chatanooga, TN In store/Mauldin, SC Mauldin, SC Athens, TN Mauldin, SC Mauldin, SC WA Winston - Salem C om m ents -- -- -- -- Fresh -- Milk in plastic & 1/2&1/2 in cardboard -- -- -- -- S to re N am e: Save-a-Lot Food Store Located at: Keith St. and Inman St. Date: 12/8/00 General Comments: Relatively dirty, outdated. Food left in boxes. Limited selection. Clientele appeared lower income. Sample Identification Save Cleve Ground Beef Save Cleve Pork Save Cleve Chicken Save Cleve Hot Dogs Save Cleve Fish Save Cleve Eggs Save Cleve Milk Save Cleve Bread Save Cleve Green Beans Save Cleve Apples Save Cleve Honey Brand Name Save-a-Lot Save-a-Lot Save-a-Lot Fairgrounds Frost Mark Rose Acre Mayfield/Seal Test Golden Bake Not Applicable Red Delicious Bramley's Processed at Cleveland, TN Cleveland, TN Cleveland, TN Earth City, MO Product of China Seymour, IN Green Bay, WI/Athens, TN St. Louis, MO Not Applicable WA Earth City, MO C om m ents ------------- Frozen Alaskan Pollock; Packed for Warwick, RI ---Milk in plastic & 1/2&1/2 in cardboard ---There were no green beans in this store ------- S to re N am e: Watson's Supermarket Located at: 25th and Ocoee St. General Comments: Relatively clean store; Clientele appeared lower to middle income. Date: 12/8/00 Sample Identification W atson's Cleve Ground Beef W atson's Cleve Pork W atson's Cleve Chicken W atson's Cleve Hot Dogs W atson's Cleve Fish W atson's Cleve Eggs W atson's Cleve Milk W atson's Cleve Bread W atson's Cleve Green Beans W atson's Cleve Apples W atson's Cleve Honey Brand Name W atson's W atson's W atson's Charlie's Catfish fillets T h o m a s o n 's Mayfield W atson's Pict Sweet Rome Shur fine Processed at (1) (1) (1) Chatanooga, TN unknown Calhoun, GA Athens, T n Cleveland, TN Bells, TN WA Northlake, IL C om m ents -- -- -- -- Fresh -- Milk in plastic & 1/2&1/2 in cardboard -- -- -- -- Farm ers Market: Not available Organic Grocery Store: Not available (1) Packaging did not clearly indicate processing location. Pace Analytical Page 3 BACK TO MAIN Table 2 Control City - Columbus, Georgia Store Name: Piggly Wiggly Located at: Traffic Circle Shopping Center Hwy 280 General Comments: Store is not well kept. Clientele appeared lower income. Date: 12/7/00 Sample Identification Pig Wig Columbus Ground Beef Pig W ig C olum bus Pork Pig W ig C olum bus Chicken Pig W ig Columbus Hot Dogs Pig W ig C olum bus Fish Pig Wig Columbus Eggs Pig Wig Columbus Milk Pig Wig Columbus Bread Pig Wig Columbus Green Beans Pig W ig C olum bus Apples Pig W ig C olum bus Honey Brand Name Piggly Wiggly? Piggly Wiggly? Piggly Wiggly? Sunnyland Catfish fillets Piggly Wiggly Parmalat Dairies Piggly Wiggly Piggly Wiggly Rome Piggly Wiggly Processed at (1) (1) (1) Thomasville, GA unknown Memphis, TN Atlanta, GA Memphis, TN Memphis, TN WA Memphis, TN C om m ents ------------Fresh ---No cardboard. Bought plastic. ------------- S to re N am e: Winn Dixie Located at: River Square Mkt Place Victory Dr and Lumpkin Rd Date: General Comments: Nice Clean Store; Clientele appeared lower to middle income. 12/7/00 Sample Identification Winn Dixie Columbus Ground Beef Winn Dixie Columbus Pork Winn Dixie Columbus Chicken Winn Dixie Columbus Hot Dogs Winn Dixie Columbus Fish Winn Dixie Columbus Eggs Winn Dixie Columbus Milk Winn Dixie Columbus Bread Winn Dixie Columbus Green Beans Winn Dixie Columbus Apples Winn Dixie Columbus Honey Brand Name WD Brand WD Select Lean Gold Kist Farms Zeigler Catfish fillet Eggland's Best Barbers Dixie Darling Dixiana Granny Smith Deep South Processed at (1) (1) Atlanta, GA Tuscaloosa, AL MO Jacksonville, FL Birmingham, AL Jacksonville, FL San Meteo, CA WA Fitzgerald, GA C om m ents ------------Fresh ---Milk in plastic- buttermilk in cardboard ------------- S tore N am e: Cub Foods Located at: Airport Freeway, ju st w est of I -185 General Comments: Nice, clean store. Clientele appeared middle income. Date: 12/7/00 Sample Identification Cub Columbus Ground Beef Cub Columbus Pork Cub Columbus Chicken Cub Columbus Hot Dogs Cub Columbus Fish Cub Columbus Eggs Cub Columbus Milk Cub Columbus Bread Cub Columbus Green Beans Cub Columbus Apples Cub Columbus Honey Brand Name Cub Foods Cub Foods Country Pride Sunnyland Not applicable Eggland's Best Barbers Sunbeam McKenzies Fuji Joe's Honey Processed at C om m en ts In store/Colum bus,GA In store/Colum bus,GA Duluth, GA Thomasville, GA Not applicable Lumber City, GA Birmingham, AL Geenwich, CT Montezuma, GA WA Loxahatchee, FL -- -- -- -- fish was not available -- Milk in plastic- buttermilk in cardboard -- -- -- -- Farm ers Market: Not available Organic Grocery Store: Not available (1) Packaging did not clearly indicate processing location. Pace Analytical Page 4 BACK TO MAIN Table 3 Control City - Port St. Lucie, Florida S to re N am e: Publix General Comments: Located at: St. Lucie Square - Hwy 1 Date: Nice clean store - between a Rainbow and a Lunds; clientele appeared middle income. 12/6/00 Sample Identification Publix Port St. Lucie Ground Beef Publix Port St. Lucie Pork Publix Port St. Lucie Chicken Publix Port St. Lucie Hot Dogs Publix Port St. Lucie Fish Publix Port St. Lucie Eggs Publix Port St. Lucie Milk Publix Port St. Lucie Bread Publix Port St. Lucie Green Beans Publix Port St. Lucie Apples Publix Port St. Lucie Honey Brand Name Publix Smithfield Publix Publix Publix Basa fillet Publix McArthur Food World Publix Golden Delicious Bee Natural Honey Processed at Lakeland, FL Smithfield, VA Lakeland, FL Lakeland, FL Lakeland, FL Lakeland, FL Miami, FL Lakeland, FL Lakeland, FL WA Princeton, FL C om m ents ------------Frozen ---No cardboard. Bought plastic. ------------- S to re N am e: Albertson's General Comments: Not recorded Located at: Sample Identification Albertson's Port St. Lucie Ground Beef Albertson's Port St. Lucie Pork Albertson's Port St. Lucie Chicken Albertson's Port St. Lucie Hot Dogs Albertson's Port St. Lucie Fish Albertson's Port St. Lucie Eggs Albertson's Port St. Lucie Milk Albertson's Port St. Lucie Bread Albertson's Port St. Lucie Green Beans Albertson's Port St. Lucie Apples Albertson's Port St. Lucie Honey Brand Name ______ Hormel Tyson Bryan Catfish Natural Eggs Albertson's Spoleto Pict Sweet Gala Albertson's Jennings and Hwy 1 Processed at August, GA Austin, MN Springdale, AR W est Point, MS unknown Zephyr Hills, FL Boise, ID Thomasville, GA Bells, TN WA Boise, ID Date: 12/6/00 C om m ents ------------Fresh Brown/ Free roaming hens ------------- ---- S to re N am e: Winn Dixie Located at: Hwy 1 ju st south of Holiday Inn Date: General Comments: Nice, clean store. Sim ilar to Rainbow or Cub. Clientele appeared middle income. 12/6/00 Sample Identification Brand Name Winn Dixie Port St. Lucie Ground Beef Winn Dixie Port St. Lucie Pork Winn Dixie Port St. Lucie Chicken Winn Dixie Port St. Lucie Hot Dogs Winn Dixie Port St. Lucie Fish Winn Dixie Port St. Lucie Eggs Winn Dixie Port St. Lucie Milk Winn Dixie Port St. Lucie Bread Winn Dixie Port St. Lucie Green Beans Winn Dixie Port St. Lucie Apples Winn Dixie Port St. Lucie Honey WD Brand Winn Dixie GKF/W inn Dixie Hickory Glen Catfish Super Brand McArthur Holsum Pict Sweet Very Fine/McIntosh Deep South Processed at Jacksonville, FL Jacksonville, FL Jacksonville, FL Madison, FL local FL Jacksonville, FL Miami, FL Miami, FL Bells, TN unknown Fitzgerald, GA C om m ents ---------- ---Fresh ---Milk in plastic & 1/2&1/2 in cardboard ---------Orange blossom Farm ers Market: Not available O rg a n ic G ro c e ry S to re: Collected 12/7/00; Peggy's Natural Foods - Cove Center 5839 SE Federal Hwy, Stuart, FL Purchased eggs, sunflower greens, wheat bran, white flour, onions, and oranges. The sunflower greens and oranges were known to have been grown locally.________________________________________________________________________________ Pace Analytical Page 5 BACK TO MAIN Table 4 Study City - Decatur, Alabama Store Name: Holoways Market Located at: Danville Road and Beltline Road Date: General Comments: Odor noticed on entering, slightly dirty; Clientele appeared lower to middle income. Sample Identification Holoway Decatur Ground Beef Holoway Decatur Pork Holoway Decatur Chicken Holoway Decatur Hot Dogs Holoway Decatur Fish Holoway Decatur Eggs Holoway Decatur Milk Holoway Decatur Bread Holoway Decatur Green Beans Holoway Decatur Apples Holoway Decatur Honey Brand Name Holoways Holoways Holoways Zeigler Southern Pride Brock's Purity Sunbeam McKenzies Fuji Pure Honey Processed at Decatur, AL Decatur, AL Decatur, AL Tuscaloosa, AL Greensboro, AL Cullman, AL Nashville, TN Greenwich, CT Montezuma, GA WA Decatur, AL C om m ents ------------Frozen ------------------- 12/4/00 S to re N am e: Winn-Dixie Located at: 1000 G Plum Tree Center, Beltline RD General Comments: Clean; the clientele appeared middle to upper income Date: Sample Identification Winn-Dixie Decatur Ground Beef Winn-Dixie Decatur Pork W inn-Dixie Decatur Chicken Winn-Dixie Decatur Hot Dogs W inn-Dixie Decatur Fish Winn-Dixie Decatur Eggs W inn-Dixie Decatur Milk Winn-Dixie Decatur Bread Winn-Dixie Decatur Green Beans Winn-Dixie Decatur Apples Winn-Dixie Decatur Honey Brand Name W inn-D ixie W inn-D ixie Gold Kist Farms Hickory Glen Fishermans W harf Egglands Best Purity Flowers M c K e n z ie 's Fuji Deep South Processed at Jacksonville, FL Jacksonville, FL Atlanta, GA Madison, FL Jacksonville, FL Lum ber City, GA Nashville, TN Thomasville, GA Montezuma, GA WA Fitzgerald, GA C om m ents ------------Fresh catfish ---------------Orange blossom 12/4/00 S to re N am e: Kroger's General Comments: Located at: Beltline Drive and Veterans Drive Average type store; Clientele appeared lower to middle income. Sample Identification Kroger's Decatur Ground Beef Kroger's Decatur Pork Kroger's Decatur Chicken Kroger's Decatur Hot Dogs Kroger's Decatur Fish Kroger's Decatur Eggs Kroger's Decatur Milk Kroger's Decatur Bread Kroger's Decatur Green Beans Kroger's Decatur Apples Kroger's Decatur Honey Brand Name Kroger's Kroger's Tyson Kahn's Kroger's catfish Kroger's Purity Flowers Pict Sweet Winesap Kroger's Processed at Cincinatti, OH Cincinatti, OH Springdale, AR Cincinatti, OH MS Jackson, MS Nashville, TN Thomasville, GA Bells, TN WA Cincinatti, OH C om m ents ------------Fresh ------------------- Farm ers Market: None Available Date: 12/4/00 O rg a n ic G ro c e ry S to re : Collected 12/4/00. Found a "Natural Food Section" inside Kroger's (above). Selected two pounds of whole wheat organic flour; it was processed at Arrowhead Mills - Hereford, TX___________________________ Pace Analytical Page 6 Table 5 Study City - Mobile, Alabama S to re N am e: Bruno's General Comments: Located at: Airport Blvd and Azalea Nice clean store; clientele appeared middle income. Sample Identification Bruno's Mobile Ground Beef Bruno's Mobile Pork Bruno's Mobile Chicken Bruno's Mobile Hot Dogs Bruno's Mobile Fish Bruno's Mobile Eggs Bruno's Mobile Milk Bruno's Mobile Bread Bruno's Mobile Green Beans Bruno's Mobile Apples Bruno's Mobile Honey Brand Name Bruno's Bruno's Country Pride Zeigler Bruno's catfish Southern Home Barber's Southern Home Southern Home Gala Southern Home Processed at (1) Bruno's (1) Bruno's Duluth, GA Tuscaloosa, AL MS Birmingham, AL Birmingham, AL Birmingham, AL Birmingham, AL WA Burmingham, AL BACK TO MAIN Date: 12/4/00 C om m ents -- -- -- -- Fresh -- No cardboard -- -- -- -- S to re N am e: Del Champs (I) Premeir Located at: Airport Blvd and Azalea General Comments: Clean, nice store (midway between a Rainbow and Lunds). Date: 12/4/00 Sample Identification DelChamps I Mobile Ground Beef DelChamps I Mobile Pork DelChamps I Mobile Chicken DelChamps I Mobile Hot Dogs DelChamps I Mobile Fish DelChamps I Mobile Eggs DelChamps I Mobile Milk DelChamps I Mobile Bread DelChamps I Mobile Green Beans DelChamps I Mobile Apples DelChamps I Mobile Honey Brand Name DelChamps Bryan Sanderson Farms Lykes Catfish Food Club Barber's Supersoft Pict Sweet Red Delicious Dutch Gold Processed at (1) DelChamps Westpoint, MS Laurel, MS Plant City, FL LA Skokie, IL Birmingham, AL Jackson, MS Bells, TN WA Lancaster, PA C om m ents Only patties available -- -- -- Fresh -- No milk in cardboard.Bought buttermilk. -- -- -- -- S to re N am e: DelChampls (II) Superstore Located at: Dauphin St. General Comments: Average store, not as clean or nice as DelChamps (I) Premeir. Date: 12/4/00 Sample Identification DelChamps II Mobile Ground Beef DelChamps II Mobile Pork DelChamps II Mobile Chicken DelChamps II Mobile Hot Dogs DelChamps II Mobile Fish DelChamps II Mobile Eggs DelChamps II Mobile Milk DelChamps II Mobile Bread DelChamps II Mobile Green Beans DelChamps II Mobile Apples DelChamps II Mobile Honey Brand Name DelChamps Bryan Sanderson Farms Lykes Salmon fillets Egglands Best Barber's Supersoft Pict Sweet Gala Food Club Processed at (1) DelChamps Westpoint, MS Laurel, MS Plant City, FL DelChamps Jackson, MS Birminham, AL Jackson, MS Bells, TN WA Skokie, IL C om m ents Chopped sirloin patties -- -- -- Frozen -- No cardboard. Bought plastic. -- -- -- -- Farm ers Market: Located at 2243 Hall Mill Road; Purchased collard greens, sweet potatoes and eggs from a man selling produce from the back of a truck on the farmer's market property. All other produce was not grown locally. Produce was purchased on 12/5/00.____________________________________________________________________________ Organic Grocery Store: Collected 12/4/00 from Organic Foods, Inc. Purchased two pounds of organic, unbleached white flour; it was processed at Arrowhead Mill, Hereford, TX_____________________________________________________ Very dirty store and clerk was smoking upon arrival._____________________________________________________________ (1) Packaging did not clearly indicate processing location. Pace Analytical Page 7 Table 6 Study City - Pensacola, Florida Store Name: Albertson's Located at: 9th Avenue and Bayou Blvd. General Comments: Nice clean store; clientele appeared middle income. Sample Identification Albertson's Pensacola Ground Beef Albertson's Pensacola Pork Albertson's Pensacola Chicken Albertson's Pensacola Hot Dogs Albertson's Pensacola Fish Albertson's Pensacola Eggs Albertson's Pensacola Milk Albertson's Pensacola Bread Albertson's Pensacola Green Beans Albertson's Pensacola Apples Albertson's Pensacola Honey Brand Name -- Hormel Tyson Zeigler Catfish Pitt's Albertson's Bunny Pict Sweet Cortland Joe's Honey Processed at Augusta, GA Austin, MN Springdale, AR Tuscaloosa, AL FL Pensacola, FL Boise, ID Thomasville, GA Bells, TN unknown Loxahatchee, FL C om m ents -- -- -- -- Fresh -- -- -- -- -- -- BACK TO MAIN Date: 12/5/00 S to re N am e: Food World Located at: 8084 Davis Hwy General Comments: Relatively clean, not real nice: Clientele appeared low to middle income. Date: 12/5/00 Sample Identification Food World Pensacola Ground Beef Food World Pensacola Pork Food World Pensacola Chicken Food World Pensacola Hot Dogs Food W orld Pensacolar Fish Food World Pensacola Eggs Food World Pensacola Milk Food World Pensacola Bread Food World Pensacola Green Beans Food World Pensacola Apples Food World Pensacola Honey Brand Name _______________ -- Country Pride Sunny Land Flounder fillet Eggland's Best Barber's Bunny Southern Home Fuji Avery's Honey Processed at (1) (1) Duluth, GA Thomasville, GA (1) Jackson, MS Birmingham, AL Thomasville, GA Birmingham, AL WA Cantoment, FL C om m ents Ground Round -- -- -- Frozen -- No cardboard. Bought 1/2 & 1/2 in cardboard -- -- -- -- S to re N am e: Food W orld (II) Located at: Forest Oaks Plaza, 5007 N. Davis Hwy Date: General Comments: Nice, clean store. Sim ilar to Rainbow or Cub. Clientele appeared middle income. 12/5/00 Sample Identification Brand Name Food World II Pensacola Ground Beef Food World II Pensacola Pork Food World II Pensacola Chicken Food World II Pensacola Hot Dogs Food World II Pensacola Fish Food World II Pensacola Eggs Food World II Pensacola Milk Food World II Pensacola Bread Food World II Pensacola Green Beans Food World II Pensacola Apples Food World II Pensacola Honey Food World Food World Contry Pride Sunny Land Farm raised Catfish Southern Home Barber's Bunny Southern Home Braeburn Avery's Processed at (1) (1) Duluth, GA Thomasville, GA Brooksville, AL Birminham, AL Birminham, AL Thomasville, GA Birminham, AL WA Cantoment, FL C om m ents -- -- -- -- Frozen -- No cardboard. Bought plastic. -- -- -- -- Farm ers Market: Bailey's Farmers Market located at Hwy 295 and Texar Rd; Purchased collard greens, sweet potatoes and oranges. Did not wash hands prior to shopping._______________________________________________________ Organic Grocery Store: Not available (1) Packaging did not clearly indicate processing location. Pace Analytical Page 8 Table 7 Multi-city Food Study Freezer Log BACK TO MAIN Study City cn cn cn Ol o oo o O OO o T em p eratu re - 1 C Not recorded Freezer Temperature Log Date 12/4/00 12/5/00 12/6/00 12/7/00 12/8/00 12/9/00 T im e 1830 hrs 0745 hrs 1800 hrs 1950 hrs 0900 hrs Technician TFS TFS TFS DLF DLF Control City cn o O cn cn oo OO T em p eratu re Not Turned On Not Turned On Not recorded Freezer Temperature Log Date 12/4/00 12/5/00 12/6/00 12/7/00 12/8/00 12/9/00 T im e 1800 hrs 1950 hrs ---0900 hrs Technician TFS DLF ---DLF Pace Analytical Page 9 BACK TO MAIN Appendix A General Project Outline Pace Analytical A-1 BACK TO MAIN 3 Analytical Technologies Group / General Project Outline To: Sue Beach - ET&SS Kris Hansen - ET&SS Dale Bacon - ET&SS Lisa Clemen - ET&SS Mark Ellefson - ET&SS James Lundberg - ET&SS Debra Favre - Pace Analytical Brad Jacobson - Pace Analytical Copy: Bill Reagen - ET&SS Rich Smith - Pace Don Stock - Pace From: Jess Eldridge 3M ET&SS Date: November 30, 2000 Subject: Multi-city Study - Food Samples > Dept. No., Project No.: 4291,0010535009 > Lab Request No.: E00-2789 > Test Date(s) Week of December 3, 2000 > Requester Sue Beach ET&SS Building 2-3E-09 Phone: 651-778-7452 Fax: 651-778-6176 Pace Analytical A-2 BACK TO MAIN Monitoring Coordinator Jess Eldridge 3M / ET&SS Building 2-3E-09 935 Bush Ave. PO Box 33331 St. Paul, MN 55133-3331 Telephone No. (651) 778-5233 Pager No. 1-888-732-6885 FAX No. (651) 778-4226 > Monitoring Locations Control Cities Port St. Lucie, Florida Cleveland, Tennessee Columbus, Georgia Study Cities Pensacola, Florida Decatur, Alabama Mobile, Alabama > Test Objective In each city identified, representative food samples will be collected to provide an estimation of the dietary intake of fluorochemicals (FC) by local residents. > Target Analytes PFOS, PFOSA, POAA, PFHS, TFA > Sampling locations and items Food from 3 grocery stores representing different regional chains in each city - Ground beef (1lb) - Pork (2 boneless pork chops) - Chicken (2 boneless, skinless chicken breasts) - Hot Dogs (1 package pork-beef mixture) - Regional Fish (1 fish, fresh or frozen, scaled filleted with head removed) - Eggs (1/2 dozen - crack open and dump into sample bottle) - Milk (1 quart, whole milk, cardboard container - dump into sample bottle) - Bread (1 loaf - pre-sliced white bread) - Green beans (1 pkg., frozen, plastic bag) - Apples (at least 2 fresh apples - note type of apple on data sheet) - Honey Pace Analytical A-3 BACK TO MAIN Food from 1 local organic grocery store in each city - Bread or flour Food from 1 local farmers market in each city (if available) - High water crop ( lettuce, etc) - Surface crop (lettuce, tomatoes etc.) - Underground crop (potatoes, carrots, radishes etc.) - Eggs (locally produced) > Sampling Protocols Sample handling: - Food items are to be handled as a consumer would handle them. - Normal handling by store employees and clerks is expected. - Each food (except for the eggs and milk) should be packaged individually in a zip-seal bag with bubble wrap if needed. The bag labels should indicate the city and store name where it was collected. - Eggs will be cracked open and transferred into a sample container and frozen - Milk will be poured into a sample container and frozen - Chain of custody forms will be filled out as soon as the samples are transferred to the zip-seal bags or bottles and stored in the freezer. Note the Special Precautions section below Field Notes: - Record the store name, city, address, date and time samples are collected. - Note the area of town, clientele and general condition of each store - Record the brand, package size, where processed, (not the corporate headquarters) and the expiration date if applicable for each food type at each location. Sample Storage: - Two freezers will be purchased and kept in the back of the cube van for sample storage. The freezer will be run as often as needed to keep the samples frozen. - All food types with the exception of the apples and honey should be frozen right after purchase. > Special Precautions, QA/QC Post-Its are not to be used or in the possession of field staff during any phase of the sample handling, or in the mobilization/demobilization activities. Field technicians will wear only old, well laundered clothing - at least 6 washings since purchase. The use of water resistant clothing will be avoided if possible. Tyvek suits will not be worn during sample handling. Nitrile gloves will be worn at all times while handling samples (except in grocery stores and other retail establishments). Pace Analytical A-4 BACK TO MAIN Field personnel will minimize contact with the following food and snack products: microwave popcorn, fast-food (sandwiches, chicken, French fries) pizza, bakery items, beverages, candy, cookies etc. - are packaged in wrappers treated with the chemicals of interest. Therefore, hands will be washed thoroughly after handling fast food, carryout food, or snacks. Prewrapped foods or snacks (like candy bars) will not be in the possession of the sampling team during sample collection or handling. No blue ice will be used during this project. > Confidentiality Pace personnel MAY reveal the following information if asked: The samples are being collected and analyzed to support a life cycle analysis that is being conducted for a confidential client. The chemicals of interest are NOT listed as regulated pollutants or carcinogens by the EPA. Pace is contracted only to provide sampling services for this project and will not have access to analytical test results. Only under extenuating circumstances would a disclosure of the results be requested of the client. Pace personnel MAY NOT reveal the following information: Who the client is What chemicals we are looking for What the chemicals are used for What is the nature of the chemicals (chemical class or structure)\ > Estimated Project Cost Based on 2 people driving, freezing samples and delivering the samples to Centre Analytical: $23,300 A cost estimate based on 1 person flying, renting cars and shipping samples came out to be $23,200 Note: These costs do not include the food purchases Actual costs are based on time and expenses > Invoicing - send to monitoring coordinator including: Invoice Date Project Description Test Date 3M Project Number 3M Lab Request Number Cost Itemization Pace Analytical A-5 BACK TO MAIN > Reporting Requirements The contractor will provide a summary report of related activities to the monitoring coordinator within two weeks after the sampling has been completed. > Safety All applicable safety protocols must be followed in the field as well as and any specific local, state, city or facility safety requirements. > Supplemental Information Pace Personnel Debra Favre (Cellular #612-720-4621) Todd Schmidt Attachments - Battelle QAPP "Multi-City Study Sampling Task (N100666) Note: Technicians are expected to be familiar with the QAPP. Some of the information contained within this GPO is covered in more detail in the QAPP. - Food Basket Study - Field Data Log Sheet Responsibilities 3M Field Analytical Services Technologies (FAST) - Provide coordination/technical support for analytical testing requirements and subsequent sampling protocols Contractor - Pace Analytical Services Field Services Division - Organize and prepare equipment for transportation to project location and appropriate equipment demobilization following the project. - Perform necessary set-up and operation of equipment - Keep samples secure at all times - Create customized field data sheets for ease of documentation and clarity - Fill out all necessary data sheets, sample labels, chain of custody records, and deliver samples to Centre Analytical. Pace Analytical A-6 BACK TO MAIN Appendix B Field Data Sheets Pace Analytical B-1 BACK TO MAIN Cleveland, Tennessee Pace Analytical B-2 BACK TO MAIN Food Basket Study - Field Data Log Sheet Regional Chain Grocery Stores page 1of 2 Store: Store Address K '^ J 'U rs + .J,i i^AJpM vgf-A^.g^ P ^ y U & je J /u rl^ T z j,^ \ Techniciiaann:j Y ^ P / 7 - p r Date: t j J & J & l Timmee:: Store Number: ' * ? < ? 7 /C 2 Q of Expiration Pkg. Size Where Processed Date Ground Beef ( ~ 1 lb): rPuomrkwCmhoppss (^2uboonneeileessss)j:: 6<-Uo[ (aQtd^yfcx-^ u33 i\^9b ltitta? I w 5~te>v-<a/ I^ I v tiun <Q&tec**sGQ--lfUca^dula(d''*',Sc- *1*i /CD Chicken Breast (2 boneless/skinless): f i U o / ^ o ld L S T iT ^ y f ) | ^ f f ^ i Hot Dogs (1 pkg. beef/pork mix): C h ulie &tu->ICS Ho C C M * u ia b y t JTVV\ Regional Fish resh r frozen): 0 . ? 7 / b S taifre/AUtcidir' > i(n (c n b ty \ >m Ig z) z-jifcnj Eggs (1/2 dozen): HMilk (1 qt. Whole, cardboard container): 1kijjfathtf- 2 5R-F55 *Ohde iXitL, E i Bread (1 leaf white - pre-slieed): fti - / u log. Green Beans (1 pkg. frozen) P)V l o / /JOiAH&rCw) t - e U. Apples (2 fresh whole apples): 3 o-o pi-es A H H A-Ui ^ A . T O n L l u jc k ^ ' QCj M ujidb'vy S e HI vvy'/tJfr */ i/tuoo/ifiIx<7j/)>S?7</* Am CAj Honey (1 container): (2 > JA General Comments (Store conditions etc.): "ho A ___l Q K lm m Q X JjolboO -i-d - bO D C th'h / A -h- m Citv ; d l e \ j - e J r 3 a i ^ store: c f a v e - o - - ) q f Store Address: O iio ( J-vw v\njn S ^h (ll-Xh^O J,'xj( -fey~y] Technician: Date Time Store Number: f? T Y P V 7 s Z5 /d 'g o / c s r l of Ground Beef ( - 1 lb): Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): Hot Dogs (1 pk Brand Name Q-')oi~ S v v e -Q -- lo ^~ Save-a- loi~ Regional Fish (fresh o Eggs (1/2 dozen): ^IVlilk (1 qt. Whole, cardboard container): Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): /S toigH & o -te AO A ed? Cy&ctA ^ K u m le t^ S Pkg. Size Where Processed Expiration Date l b $ 'sic^ 4 2 5 _ lk 5 Ci-\)ejo-v-gi ,T 6v>^ V o A U ] tbs le OefcuYj. Tenn LL la l> S'Jja ``inHftii'lf-j P-1- ^ e ^ puciUt; 'C'' A ^t^s, n&v,MCUOAJ, iSC i^ / ^ / oq lo g ~ f & -l i< , kxo . j U 3 g GUPOV&- Q ir S jntCUif UP General Comments (Store conditions etc.): r e i ^ ^ L f c U v fg s ix * * e U , >f?/i rh t o ec;, kX C S f SihJ rn f t u llL , U h J k r J Z e je r . h J t ' . l G v w * ffn tlc Q * M a t i te j p f i V p w k i f c o l K > k COuu (qQClhJ ' b o u o i^ j- x/g ' Pine.fir nu^r) i p ' / j iK ---------------- { 7 ^ M rlflQ T ic Pace Analytical B-3 BACK TO MAIN rood BasketStudy Field Data LogSheet Regional Chain Grocery Stores (continued) page 2of 2 Store: L a y - r i's. ^ Store Address: Q^A Q Cn e e. M ^ \K ) jjfU ngl Technician Date: Time: Store Number: Ground Beef ( - 1 lb): Pork Chops (2 boneless): Chicken Breast (2 boneless/skiniess): Hot Dogs (1 pkg. beef/pork mix): Regional Fishy^Tresh^br frozen): Eggs (1/2 dozen): Milk (1 qt. Whole, cardboard container): Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): Brand Name LLJcxJ ^ cjvx K> Co-ptw (e.V> 'TlAYyvxsanS m iZo w v Sm Pkg. Size o & b tte i> c 3am & \b C>tr Where Processed i to r n `y te v -e -'j (Uv&a*i -------- .TVi \JU-\ CUOIQ^\ QQ--- O levLXiM A .T ia UJQ-9hi ! IQTOK Expiration recti? On A )ft L> P* General Comments (Store conditions etc. cnu 'tC)M/ ^ h' n n W i - v e oeJ h f C~e Store: Store Address: Local Farmers Market (if available) Technician: Date: Time: l C @ ^ / Surface Crops (high water) X if collected Lettuce Tomatoes Oranges Grape Fruit Other Underground Crop (high water) Potatoes X if collected Carrots Radishes Onions Other Field Observations: Eggs and other produce X if collected City: Store: Store Address: Organic Grocery Store o/fir Technician Date Time Note items obtained (such as bread or flour): Pace Analytical B-4 BACK TO MAIN Columbus, Georgia Pace Analytical B-5 BACK TO MAIN S O d B u t S tu y _E i ld Data Lag Sheet Regional Chain Grocery Stores page 1 o f 2 M ---- ^ ' ' - ' I Store p m E j U A qtj/u Store Address T p /X ff-iL ) r ) U J * & ^ h n p p ! r e f CsJ-t' jp/nm JfeT U C M / 4 Technician: Date Time: Store Number: Ground Beef ( ~ 1 lb): Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): Hot Dogs ( 1 pkg. beef/pork mix): Regional Fish iffesm or frozen): Eggs (1/2 dozen]: Milk (1 qt. Whole, cardboard container) Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): Brand Name Pkg. Size Where Processed tia a lH M m h p h UXqcf}xy <P ,>t l b S (i/\ in $ fs > e IbS in jclMepf llo 6 ^ j 2 r^ o ^ L -e - C c ^ f c > h H l& $ j.H tb <> P'Q4luU)i#a}\J d = k UckiLki^ / B qqiy khe^/Lf f ' f i l i j it'cfaJy iL O t 3o-P P )-es t~ l r U iiu fh ic,^ T & \ V) _\j.c. ^-->i ^`uy.^ITir-^e.wn /U'*nPht\T&un Expiration Date L^/iiolev / 3 / z .WOTD f^ /^ / i-^fCTbo *>/>>^<57J fIt l(M'A T5F* General Comments (Store conditions etc.): (U O -Q b kok I u jin to Store: Store Address: h ii Technician: Date: Time: Store Number: Ground Beef ( ~ 1 lb) Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): Hot Dogs (1 pkg. beef/pork mix): Regional Fish resh frozen): Eggs (1/2 dozen): yiVlilk (1 qt. Whole, cardboard container) Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): / ( 'e"?U->VWr U \ V '" . Brand Name Uj QP)icuv) m b beA'e.cA- L-e-*'1 Pkg. Size iS ib tM > /to Where Protcve. IM ^ v e . T v j^ c o -to c .^ vtkxtw-nr_ SV*-ViuXVxufchxOv-S*v^\Tw Z' 0 0 /t i O U ^ ' 1 ( Itxxf- ' JjczwJiJt S u i k-efeo ^ G jP p ls u ^ l g ,s k.<V /W f) SbftA / -2- F\f~t<><xa (td Expiration Date 1"O- to/gZs /3/oi /Q L) /U M A iM mments (Store condGitieonnesraeltc). /jtC .T l , $; / r u ; - % T ) 2 k / ( ? & 4 T * V i y ^ U ^ yjlCU<^~ lM ^ k r i O M \ e t U J l L i n ) L < ! t i r . * P y o t k J U ^ j L . A A r a ^ M Y y ir Z v Pace Analytical B-6 BACK TO MAIN rood Bnkit Study Fisld Data Loo Shaat Regional Chain Grocery Stores (continued) City: C f i u j b v Store: Quid Store Address: 6 te c ^ Ia tJU e.Q f: 06 Technician: Date: Time: Store Number: page2of 2 t% 2*> ( P s r \ Brand Name Ground Beef ( ~ 1 lb): Pork Chops (2 boneless): Cok3 Vco-C Chicken Breast (2 boneless/skinless): Hot Dogs (1 pkg. beef/pork mix): Regional Fish (fresh or frozen): S o v^v^Vcu-ygA Eggs (1/2 dozen): v^M ilk (1 qt. Whole, cardboard container):. u ^ t e k T c / Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): S~U<AW - C m r x KC[LexA'bn **7 EfcV J o e 's nts>ve-Y Pkg. Size Where Processed Expiration Date b 'V it I* lite r lb $ (o 3- IlC- L-G&zl^ d t 6 (- iLwvWefr l i e f e r t Conto |/UOY>-te.'Za^jnA | (sA Im pilai f ecu A->rV" LotAkutcM-jp a j >a General Comments (Store conditions etc.): t U ' t CLbapJ-n dcLLe_ (U <X9f > , ^ h-^SVe U4( IL-1 m pyx e ftC / y\r!l-a\)cubM^) <b ju III |w% _________ / Q ^ ^ u U > T ^ __________________________ Local Farmers Market (if available) City: Store: Store Address: Technician: Date: Time Surface Crops (high water) Lettuce X if collected Tomatoes Oranges Grape Fruit Other Underground Crop (high water) X if collected Potatoes Carrots Radishes Onions Other Field Observations: Eggs and other produce X if collected Eggs Cheese Milk Other Store: Store Address Organic Grocery Store Technician Date Time Note items obtained (such as bread or flour): Pace Analytical B-7 BACK TO MAIN Port St. Lucie, Florida Pace Analytical B-8 BACK TO MAIN Food Retata* *udy Fiold Data Log Shoot page 1 of 2 Regional Chain Grocery Stores iW /3City: IQJf P n v t^ i- l 'Store: E Zbx T=b~y u ^ / r p cTechnician: (buz)Date j z / u n r Store Address VS t j-tit e_ S0-7 Time : ^ i n i b i r t i . Store Number: P tS t.(\ e { p a - Brand Name Pkg. Size Where Processed Ground Beef ( ~ 1 lb): Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): pCJtP K L HM b S v * -frfte b f f i g g a r ior T. / \ I b PcjubUx 1,13- I b jUPa JOlMcII .... ; \b --/ Hot Dogs (1 pkg. beef/pork ix): Regional Fish (fresh o/frozen PuJbU Eggs (1/2 dozen): P o-^O X 06<n 'Fi Heir COdLi X Vf o o > t t ll k (Ptbli tra lO y x ^ Milk (1 qt. 'A/hole, cardboard container): Bread (1 leaf white - pre-sliced): Green Beans (1 pkg. frozen): kkc TvcxX UjcMcJ PuJq U k tr Ib C & r M tb u n l1 Lcuay>'l! t t d Apples (2 fresh whole apples): Honey (1 container): iS-b: Q lcie yx f Y A t a oe S ^ c x p p b j LL f a A k y ^ - U fl&ney l ( Cft PdnC^-kSh Expiration Date 30 l ^ leso O -H f& D O /ift/o S /^ / ) o ls tC j/a o l -I do ja r y /J A /O A A j/^ r General Comments (Store conditions etc.): J'fC, C J &u t ? h T7 l 4 Jl\h rL^, L U n a J m * -fn f i h d ( ^ d j p r a J h i k . n u f t ^ /V O a i ^ l P r i v d c r \ f e u w i x - b & > U f~ Cltv: /> Store: ^> P j i ^ f S<n-*t-. LJ >-C j f R Z Store Add rass: ^ |e - r > n V > ^ S O M 4 Technician: Date: Time: Store Number: X F /T F ' m i* (6 0 D ->D f e s r ) Ground Beef ( --1 lb) Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless) Brand Name Pkg. Size t><4 , 1*0 i\Q$ Hot Dogs (1 pkg. beef/pork mix): Regional F is M fre s ^ p r frozen): Eggs (1/2 dozffjT^pu-i^fee (titu W J . ^ 3 3 )(. lo^) l b / doZ- Milk (1 qt. Whole, cardboard container): Albe>t^5KA <3>-fc Bread (1 loaf white - pre-sliced): <z>0&bcJt2 Green Beans (1 pkg. frozen): AiAteiueeJ- Apples (2 fresh whole apples) 3 ^1 ^ Honey (1 container): AlkiiEtiSVvS i l oGeneral Comments (Store conditions etc.): Ck ta :/UreyHfl-P:. U</!/- Where Processed -flu fru n j/u J S p * i i Av Point <Us U ju it^ ic rL u u o Expiration Date > /io /c n i /^ T i /SO TUCVW3-6N o e us__ T g vM Uj^GhtVvrfcrrv & b r , J tfW ic <s <oi i^ r JU /? AJH Pace Analytical B-9 BACK TO MAIN F99dBasKet Study- FieldData LogSheet pago2of 2 Regional Chain Grocery Stores (continued) City: A t Store: Own Store Address: t^ f- v>4-- cA-l4Vd^T y ^ 0^1-S t 1 ^ Technician: Date: Time: Store Number: n t z rl2H> /C D Ground Beef ( - 1 lb): Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): Hot Dogs (1 pkg. beef/pork mix): Regional Fish ifre p ^ o r frozen): vov Eggs (1/2 dozgfi): J ^M ilk (1 qt. Whole, cardboard container): Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): .toiVin u(e2 / B r a n d Name Pkg. Size lu ) vCHoc4 11*4*4 fb U K v w v O l (i>- (b fc>i^F/vnh Ite 6 )^ 4 a __ I - C fh 0 Hto ibS v > p e ^ \d /d dOfe MttiLltiliP- j_i ACKkf_ hhlSdYvn / /l/1' VicJt Svj>e ^-T S^-Gb $<xjophe? & 02 Expiration Where Processed XfluWtCfrW _________ Date [3 r j^ (O Q ~ ia lta ico /tt -jc IcC&JL F moQ#-' Alitimi., FI*LUeu*j{ Fk- I^ IgO ttm I /. i BJls, Tenu UJU CJaIUjT PnhZC^-eUCldga^i^e- A f~ r IGft & fa io \ General Comments (Store conditions etc.): /L h ^Q j ^ g j n x f d i ^ f n C n (&j K i j'h h G l u -- p w d uJUoW3 n u I io (!A C 'n x s ib o & M z t P A 1 <Zr> b rk jo t i t , --------c \ y \c ) _________________/ <yt4r t A 4 y b f(A CgsA b c & jh J ______________________ __ _________ Local Farmers Market (if available) City: _______ Store: _______ Store Address: Technician: Date: Time: Surface Crops (high water) Lettuce "X" if collected Tomatoes Oranges . Grape Fruit Other Underground Crop (high water) Potatoes "X" if collected Carrots Radishes Onions Other Field Observations: Eggs and other produce "X" if collected Eggs Cheese Milk Other Organic Grocery Store City: P q u + S f. L u ce p i ^ Store: Store Address: g.J-&Dd -4/> E e d ju o A h ftu W Note items obtained (such as bread or flour) 3*4*1*11 Technician Date: Time: i^ p /rF S fH GO &&J P jzJc Pace Analytical B-10 BACK TO MAIN LU^5U>e ?f- uJ u x n jlo l Ls J-&^rne_^S AAp<jJ^qJ~ ' Qb Uj- b c iP jh lr ^j~U(L ^/ldU nhcjr /"fc-hn$ cUT~ O n O u j a j c ( jt 'o c e n i S / c ^ / p e ^ y '" \ ) --'LL_ I c b 2 r ( ov^ c l m i w ^f-ve- 6 o l c ^ 9t. /Wqo^-ti tv e .fq o - i> /n /e C . y r f l A r u * ^ " f i h m ^S $ s i^ < 3 W c ) *5" ^ uvc,Vvvie . u eer P ^ 0ptcJ'NF <L' '-G _y_p. ^X <L ^ s v t 0? ( ^ vC jJ/i ( C L Q y ig jx J f' f^ \ / u n I b ~~ h O - j- u a jL ' /K p c > X^ Jo Jo e ji Cod lOll&i^- ffs C V ^C X \r^ 2^ Kj J H $ fj-Q '-Q -f& i'C ^ T ^ Y -O ^ /(jc> ' y p - c fo tfc ^ ^ ^ ^ X V l S (jLBr\Su-i^& U Ji,j-ex^-e y ^ /iiU y L i^ evo lo Jo o JL \(\e P j Q y q jU / ^ io Q v c u r x c ^ e .^ Cj (/c n o h j o c c x j j i n 3 p fo jo e J lc K ^ Pace Analytical B-11 BACK TO MAIN Decatur, Alabama Pace Analytical B-12 BACK TO MAIN Food Basket Study - Field Data Log Sheet Regional Chain Grocery Stores page 1 of 2 City: store: ^ Store Address inj^/ lUnuspj- Clint: J + vU' j J -ecn b j * . M a J o o ^ v t^ y Ground Beef ( ~ 1 lb): Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): Hot Dogs (1 pkg. beef/pork mix): Regional Fish (fresh q^ftozenjT ) Eggs (1/2 dozen): Milk (1 qt. Whole, cardboard container): Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): Brand Name Bciouuxu'S HoiHole a u l S M ! \xs &vo6Cl5 P lM H 6 uv\b eo ^\ ilA^-evv^cs p J V -tL - jj-CyycLLj Technician: Date: Time: Store Number: XXJFV T~FS <28I 0 h iS Pkg. Size i3 J b 4 |.< n lb^ Where Processed /ritxia xw T a- Expiration Date fiC U lC isi &2J2#l Aw-n 1 M 4 5L lip O t I b o i- ' kivt- L lo p f to m a ***' ,, T^TTTTT ___ are^vtfll ^ rtlAl/yum-> 13-) ioahd'- H *i--e x nC &C C )?-/ 1 ^/tQ d elfiitje'insn'Afitt.c, - iwcwrcfc>-**'. U jC ^ 7 ^ ,V \tt5 V \ D U X JrU '/ A iO-k)fl-vC-- / \ j A- General Comments (AStore con,diti.ons etc.): ------------------------L f r t f M ----- ----(-KVc&Z)' j U je y sf h A a c ii r j a ^ City: \e rc d tu ^ PbcUnLvrt^ store: Store Address: y/-e JOO Oi iM lp t C & rtu -- 'eJ+iinf ri. V lc x tu /H -b g j^ a __J Technician: Date: Time: Store Number: h /tE S >-7m icsu 95c) k.rrs Ground Beef ( 1 lb): Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): Hot Dogs (1 pkg. beef/pork mix): Regional Fish or frozen): Eggs (1/2 dozen): Milk (1 qt. Whole, cardboard container): Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): Brand Name Pkg. Size iOr> f ly c v n d ioivih *J t L.<^ l b iU> i loFi U-idtcvyfer' 1=*^ vrttJtcu f- f o i fe |bS / ^ - O 't" 33>/b5 i doe P o ifH p/tTLo-e^S /Uc ie-*2<e*s Q t; /. OCLf t e Cfts i &ep Soviet/e^s!rJ Where Processed wv.n to x ic to tw!Qo.CC<i^^yiiie-rDv^ /UdU^cnn -i>fcV)A hfXl'C. Uv*bd'C MsstvJiijt. Expiration Date S tric t* >llo / > / ? ( )cst> f je te i* lt&/ 'xrci gltfovrt /UQSnitryy f t y General Comments (Store conditions etc.): C Jip s' -kJe - f\Mk. Hj Pace Analytical B-13 BACK TO MAIN Food Basket Study - Field Data Log Sheet page 2 of 2 Regional Chain Grocery Stores (continued) City: Store: c a ^ 5 Store Addresss: - t (h n A VQ-ht/hS b ^ h Technician: Date: Time: Store Number: E X J P /rf^ \tr/u\ f q j /a d o Brand Name Ground Beef ( ~ 1 lb): e v Pork Chops (2 boneless): Chicken Breast (2 boneless/skiniess): CMQa TO Sein Hot Dogs (1 pkg. beef/pork mix): hkVt> Regional Fish /fre sh o r frozen): IO/Cd-e*-'- Eggs (1/2 dozen): iMY/-ev Milk (1 qt. Whole, cardboard container): Pbv'i f-<-4 Bread (1 loaf white pre-sliced): Green Beans (1 pkg. frozen): p f`6lOCt^> Apples (2 fresh whole apples): Uj,Yy&S<xp Honey (1 container): General Comments (Store conditions etc.): Pkg. Size U S IbS l, ow lbs 1.9-4 f b s 11,0h 0< / dt / 6)fc J Ic ^f 5 ^ ^T 3 CLpUS -fc Where Processed (L\y\C<i'Vfcfocnh>0K6 Ohio 'H *c iv ) .$ \j(iW B ^ s, T-awm tO&ShiV^fe^ CUtM^viCdX' W o Expiration Date /U h 1 ^ io-U jcxo o-lbiou Y/i ^ AJA /u ^ Store: Store Address: Local Farmers Market (if available) AJcvv^- A 'OCwioJo VCj Technician: Date: Time: i> L F S > j H j f i l l Surface Crops (high water) Lettuce X if collected Tomatoes Oranges Grape Fruit Other Underground Crop (high water) X if collected Potatoes Carrots Radishes Onions Other Field Observations: Eggs and other produce X if collected Eggs Cheese Milk Other Organic Grocery Store City: /iJbLL'ii-' Store: ______ i/ u q - e _ ^ < fy p L iry Z a S do(jsr4~ Store Address: Q o J - h in A e \U s i-e iJaJ-o w x^ t o o d S?C b & n yH s / e ta & i-o s Technician: Q t > ~ / T ~ p S _________ Date: hjbfi} / f fj_____________ Time:____l ^ u __________ Note items obtained (such as bread or flour): / UbiolcubUtciJ' yU U J-- i^X iq / c. C3l Ho S> fLCtlh ~ t'\/ Pace Analytical B-14 BACK TO MAIN Mobile, Alabama Pace Analytical B-15 BACK TO MAIN Food R asket Study Field Data Log Sheet page 1 o f 2 Regional Chain Grocery Stores City: J d b l f Store -- Store AdJddress: ^ a J z x J r ia ^ y ...................... . f s iy g / OOnd ~ M b > te t 'A k d o J v a ^ ' Technician: Date: Time: Store Number: j{ \ I3 rtn / J z T /8 5 D Brand Name Ground Beef ( ~ 1 lb): q u s b y j Cjm ^z Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): Hot Dogs (1 pkg. beef/pork mix): Oxobif fa id e Regional Fish(tfres^)or frozen): Eggs (1/2 dozen): Milk (1 qt. Whole, cardboard container): Bread (1 loaf white - pre-sliced): O W -^Ask ^Oh's') 5b\j'fvw z>^ P)OJ'bej^S svb^ej^\ ffar>e Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): S n x jh ^ 'i /-fan#. & od o-- /qfchTe Pkg. Size l *?LJ uoj 0 0 / /b $ / , o 3 />s /k o z r. .fe f) IV * / niCFfn <5>t 1 OJF- 3a. Where Processed fiWVG ^ /V u n o 'S b liio th j Qeiscj 7WSUfc&Lt A l. A-tlSSt 5 6 i p p gt-Hnvtjharfin (p m ^ b o fc UJ&$hi'nojcsr\ >\rm\Yqkcylv\ ,Ai_ Expiration Date /^ /S /0'~> i&* 7 /fcJO..... ^/^/ /O A a ja ^ / o i / g \> ^/c u KOp, /J tf AJA -Sioi/Q CI y\-ld-e /uidLo CJincidi nommeras ^rore conditions etc:,).:)i:^ l- C ( i A ^ JTQi/fc^ U I( : A J id J il o JjJnab t, to fin d txjhok. U\\\L ; n CxudL/PQauJ boQkf p fr W7 1do Ip A ia b r u n Store Address: Technician: ~Date: Time: Store Number: pS> l -1 ZZT* Brand Name Ground Beef ( - 1 lb): Rl Hv ^ ANOtVaJoVe Pork Chops (2 boneless): vtj Can Chicken Breast (2 boneless/skinless): SLVx^et'^HftivmS Hot Dogs (1 pkg. beef/pork mix): Regional Fishfffres^ or frozen): Eggs (1/2 dozen): PrSh Milk (1 qt. Whole, cardboard container): Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): O fS uj e A heX iiJO J^ j)u4cVh n )d Pkg. Size 1 .5 ft fu>5 / 37 /b^> Xi h o__J_h ( d^ J .ftt i./cfrf /(> o t ? Ci_ppl6` / 6 ^ Where Processed Laurei, M i 50 Ras lcJlnStQ-b-> SAUe, X V \;^ s Expiration Date 1 tj ___ fS g jfc / I i r j q jcsu i d -7 fb \n t> i <;^,ppV- tie lls f 7 A )fy A J /f U^^ca5-kS) Pn^ r~ -- ---A-j--A--- ----- General Comments (Store conditions etc ): d l e O M l A l f f i S f e v P / ? te - f a x t e n L U n & f lt ; p (n lrv j UJInoVf l r u H U w r V i. it ) WCM i 0)>t to t IlltM ') t It ltn/nt|g P , r r jf a . / U / / / Pace Analytical B-16 BACK TO MAIN Food B asket Study Field Data Loo Sheet page 2 of 2 Regional Chain Grocery Stores (continued) City: fik d o iU L store: j y i c J ^ ^ p s / t ) Store A^c ess: O o jopP wiu l^ ' O f H J h O - M . v^owc-cujo-* (<xJAe.,bcuq(VTib Ground Beef ( - 1 lb): i^oed^yjb^r1 Brand Name Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): Hot Dogs (1 pkg. beef/pork mix): P)Vu(CU-> ScL^cLevSdP''' L q K e 'S Regional Fish (fresh o^frozen): Eggs (1/2 dozen): 5d-iv^<5v> p n i- e is -g c ^ia j^ ts Milk (1 qt. Whole, cardboard container): Bread (1 loaf white - pre-sliced): & xx'be'S Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): PiC-HSco (zDcxJtO*. Honey (1 container): T tX ^ C J lo Technician: i n / z H 2 L _ Date: --Time: ~m Store Number: Pkg. Size A .tp l l\o5 .~ > l IV>S l.L B ite6 tie ft- l'o s 'd o Z- l t i lo o -f ib e t 3csppVes t . Where Processed ( \ ICLLv3lu^P S ? Lo* fu> U X o '-e t, M.ISS. pjt. O ei<U -v^p^ octTxyn, f a j f , fy.VW\\W e t^ T e w r UJc3.*bh S L ^ e , xiW vofc Expiration Date i j rlc fc i (O b 1 i joZj i ^ Ie/7 , T 'i/o V ^ m fo u AOA KJPr yO A General Comments (Store conditions etc.): fj'jZ X 'tX g fL lr\i~C L S C l-e g j^ r>\s lotC-e. i y z ( V 4 O o ^ p s / r A - pve_ls-net . i.ih < 3 J o ie tv U J h n V e Aj u / IL - ii/t Co j^A Lx n u i . ..... h o u g h T fJ k id rh 'c ^ Local Farmers Market (if available) C'ty' j A p f o X t ~fikX -D & lA \A y Store; ----- 'rtW jlX k A /i iMo T Store Address: h f a i i A J i \ ( Q .A AAf ih i W Is ri Technician: f o \ j h / r i ^ s Date: I v - f r / a i , Time: -- A l ' - l T ___________ Surface Crops (high water) Lettuce "X" if collected Tomatoes Oranges Grape Fruit . Other Tsp > ^ 5 ------- -- Underground Crop (high water) s u u e e tPotatoes Carrots "X" if collected V Radishes Onions Other Eggs and other produce "X" if collected Eggs y C h e e s e ______ Milk _____________ Other Field Observations: PvOiyjWF f o l / ic e rf ~ ^ J A c ^ ] lr\ r r ^ u n J ^ L U ^ ig P i g j uC<i f u / y * Organic Grocery Store City: L iO k lI L , d tlh Q j ^ !. Store: O W f k M i c . ^ r r r ) ^ X h r , 1Store Add<rress: H i_htL_____________ u ft*o tv ** Technician: Date: Time: i d j U OQ <" 7 ^ 0 Note items obtained (such as bread or flour): ^ l b ^ G v G & U x ul irtt e u C h e d ! i i ) l o i f e j ^ ( 6 V ^ __________ A -W S 'V I r . J In , It C U - . ^ jC ,N ,T r ' Pace Analytical B-17 BACK TO MAIN Pensacola, Florida Pace Analytical B-18 BACK TO MAIN C ity : Store: Store Address: C.&d Q&&U& S tu d y - F ie ld D a ta L e a S h e e t page 1 of 2 Regional Chain Grocery Stores 9^ w ew t Technician: Date: Time: Store Number: mL=EV/ F FES Ground Beef ( ~ 1 lb): Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): Hot Dogs (1 pkg f/pork mix): Regional Fis fresh p r frozen): Eggs (1/2 dozen): Milk (1 qt. 'A/hole, cardboard container) Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): Honey (1 container): Brand Name i-fo o T v e J t T m S ct^ * e iAQvVteLjs o ft TF a .Ojbv H & J /Y . io ? f-ksnejuj Pkg. Size 43_Dq 6 7 t lb (21 l b Expiration Where ProcieVs>sed p rU )\j~ ,^G e o ^I CL, Date &\3 R-vjG+To <(7vi inq i l ---- J --- &XJ2UX& '^ i n / <bl (b f d<A ; a > tr 3 3 cR r- 3 a ffia to ?<> CTZr - f r v \d~s Pza* 54CCAO-j r 6o>5e 'Hvivvv'M Sells. s iAVfink.n L l^ ib a J c .b ^ e ' ?4h LEE *O F tO P - A J^ A JM General Comments (Store conditions etc n )c -e ^ , O j e^-kJ-e- yluclclh CJa5S c 'ty; Povi Sa)Ig L . ^ R u id o ^ Store: Store Address: :Technician: - A F V7 7 =. Date:: W s -c ru Time tun Store Number: Brand Name Ground-Seef ( - 1 lb): vtruv^Ll2uvv^ Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless) Hot Dogs (1 pkg. beef/pork mix): Guncl Regional Fish (fresh Eggs (1/2 dozen): Milk (1 qt. car froze O-Va i 'iayvcLen P U le i C/)4ind'S Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples) Honey (1 container): m A v ie v U ^ Yk$neu Pkg. Size Ale j b ^ > on<^ ih O tfsrlbz I> i . /.a o / lb f cx2r Ko QH cfb General Comments (Store conditions etc.): n ? J o M / p : J p n 1iI - k i W (U e d J n OJa as Where Processed ha 51"Cv-e_ i n *0>+OV~~? Xi/u+vw fo-- -cw^Svi/r? I H S rove jESV? /UvS5 Z ^ o ja < YttO viAsy : f t X ?----------------- 1. ^'.uvv"W^toU,i VaShi Qa^rVomeL^Uj T. HJ Expiration Date la /^ o i^i)))o a i fi /C /u/a (u n n a t a m i h c < Pace Analytical B-19 BACK TO MAIN F o o d tbaskei Study - Field D ata Log S h eet page 2 of 2 Regional Chain Grocery Stores (continued) City: ` ja - f u f a . ' r ' / A V y J l ? -- . Store: T b y ri Y X yirf f T l i i Store Address: Y -fd f t ^ j- p v e s f- a lt P ^ s -- - S C lA J -iM is Brand Name Ground Beef ( - 1 lb): Pork Chops (2 boneless): Chicken Breast (2 boneless/skinless): tR p d t J ^ s v i J P ^pA .bP cM d Cpui't+u-f p y ic ie . Hot Dogs (1 pkg. beef/pork mix): Su</>viu\<3uAd Regional Fish (fresh roze X&stf' fo-iscd GdrP&V) Eggs (1/2 dozen): Milk (1 qt. Whole, cardboard container): Bread (1 loaf white - pre-sliced): Green Beans (1 pkg. frozen): Apples (2 fresh whole apples): O U vikicj OlAfriano ritvrvg. &VG& lc7 L )< /n Honey (1 container): A m o -^S Technician: Date: Time: Store Number: U 3 WoPkg. Size /) .6 Q (<o ft r I/o C>t <P.OS t b \ d? Where Processed } iA S-fc>ve_7 itA S f e ^ e fcOldHA vcoK '/ileT'. v v h i W c t-jg 3 3 o 2 r- 3 g-p P i^cs 9L CL- 'fW>wx<iS>l nVl/V'l1 iCM/v? Uj-Sl^ I I nqr -/CVN C & . w t o v " \ m e j ^ .1 Expiration Date 12-l b [GO I 2 -In/ y A Jrt /u A A J /^ General Comments (Store conditions etc.): h j dLihM J V ( f i l G j-y e w k v e -. u i c l/ U l O a s v aJdVf fc> UJUoV n o l le iw CO-Lribcru-A ( AVri r u i o r t i Q U i City: P e v \S a c d a S to re : ( y j'/ e L j^ pU W Store Address: / ^ n y j f t f Local Farmers Market (if available) Technician: l < ! Date: Time: s -/rj Surface Crops Tomatoes range Grape Fruit Other X" if collected Underground Crop (high water) U >62*9 Potatoes "X" if collected Carrots Radishes Onions Other Eggs and other produce "X" if collected Eggs Cheese Milk Other Field Observations: O n j u a \J O J I Q )o t& J o J U u Q l/V lU H D i / r i P C e | > | A J f u J 'r & i j M h InO u n A ? b e f a jp S h b p p / w f ' ' Organic Grocery Store City: Store: Store Address: Technician Date Time Note items obtained (such as bread or flour): Pace Analytical B-20 BACK TO MAIN Appendix C Chain of Custody Forms Pace A nalytical P a g e C-1 BACK TO Pace Analytical Page C-2 Client Information: Company Section A Required Client Information: Report To: Invoice 'roject N um ber: CHAiN-OF-CUSTDY /Analytical Request Document 574001The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B T o B e C o m p le te d b y P a ce A n a ly tic a l a n d C lie n t Section C Q uote Reference: C lie n t In fo rm a tio n (C h e c k q u o te /c o n tra c t): R equested D ue Date: Project M anager: Turn aro un d tim es less than 14 da ys sub ject to lab oratory and con tractual o b liga tion s and m ay resu lt in a ?Rush T urnaround Surcharge. Project #: P rofile #: CO to |T u a i A ro u n d T im e (TAT) in c a le n d a r d a ys. Requested Analysis: s S e c tio n D Required C lie n t In fo r m a tio n SAMPLE ID One character per box. (A -Z , 0 -9 / . - ) Sample IDs MUST BE UNIQUE V a lid M atrix C o d e s -4- -- M ATR I) CODE W ATER WT SO IL SL OIL OL W IPE WP AIR AR TISSU E TS OTHER OT L I 2OE / w 1 O '* " a_ ( M. y r p n aJ J* tK ( i &i ON j 1 r\ r * :< ri m *A w ,1 _ F i i Isli ; r"X ' iS lu i L > e c - f r V, e;* ili 3 i f JV> A* / V U <C fp IP S Q LU LU Q O 5 LU O S .d X cc o o UQ1 5 LU Pd oo 2 m m / d d / y y h h :m m a /p # Containers Unpreserved I NaOH P re s e rv a tiv e s o CO d z XX o X Q CO <5* rz k h o 0^0 { i 1I 11 T" r~ t I1 f f1 / // / /// // / m HI s l B ||3 i lili m H | | llliw -- *~ lili R e m a r k s 1 L a b ID ........ iV f i l l iWv. i a f ' r|RS J " 4# ta c O' " B V i , a p &_Ls -y l- A M M ( r > \ V ' h " p X V s } fI u '. V 1 1^ - i A . A 4 ef :g|! p iig 4 . J S j mk l t e i tpfepf H 1 . / \1 / \( pie C ondition Relinquished By / Company ______ ^ P inc':*p" 11 " T F S Received oh ICE: Y/ N 'T 7 r 5 / A c ts 1 lip is . f^ j ; -'i i' ' & s I Date Mi. p j l I Time | Accepted By / Campai 1 1 ' u" 1 ""'-'VU..... > ' CjQr. p f| ! s. BH 1.1 ; ir Sealed Cooler: Y/ N Samples Intact: Y/N Additional Comments: SAMPLER NAME AND SIGNATURE fR IN T Marne of SAMPLER: _^^hA. SLANATURE of S A M P L E R :^ DATE Signed: (MM / DD / YY) SEE REVERSE SIDE FOR INSTRUCT* Pace Analytical Services, Inc. Form COC01 02/00 > -y : Address 11';-' Elione n i) W .iXl CHAIN-OF-CUSTODY / Analytical Request Document raceAnalytical C c l \ v \> 574002The Chain-ot-Custody is a LEGAL DOCUMENT. All relevant fieldS-rnust be completed accurately. P iW o c M o u Page: of T o B e C o m p le te d b y P a ce A n a lytica l an d C lie n t Section C tjJ l ^ 0 4 - t o ' M l R ep ort Tp: rn d c a jb ? M n ___________________ P.O. ,f iW | / jI P j C lie n t In fo rm a tio n (C h e c k q u o te /c o n tra c t): -- ------------- R e q u e s te d D u e D a te r *TAT: Q uote Reference: Project M anager: k Turn around tim es less than 14 da ys subject to lab oratory an d con tractual ob liga tion s and m ay resu lt in a JHush T urnaround Surcharge. Project #: P rofile #: O u m A rou nd T im e (TAT) in cale nd ar days. f :ax Project Num ber: . ^ *\ Requested Analysis: R e q u ir e d C lie n t In form atio n: SAMPLE ID BACK TO Pace Analytical Page C-3 Additional Comments: SEE REVERSE SIDE FOR INSTRUCTION: orm COC01 02/00 > ^ *3C6An3lytiC3l C ^ Required Cl_ie_nt_In_fo_rm_a_ti_on_: ____SSeeccttioionnAA Company Address ^ /U P m /1 Required Client Information: CHAIN-OF-CUSTODY / Analytical Request Document _ 574003^ a'n ,s0^ USt0^ a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B Page: Section CTo Be Completed by Pace Analytical and Client Q uote Reference: C lie n t In fo rm a tio n (C h e ck q u o te /co n tra ct): R equested D u e S a te : "TAT: Project M anager: 3ro ie c t N a m e : * - .. / I k T orn a ro un d tim es less than 14 d a y s subject to la b o ra to ry sa n d co n tra c tu a l o b lig a tio n s a n d m a y re s u lt in a R ushj^um around Surcharge. * P roject #: P ro file #: g c x i jL ^ X Tim e (TAT) in cale nd ar dSys. Requested Analysis: j Section D Required C lie n t In fo r m a tio n SAMPLE ID One character per box. (A-Z, 0-9 /.- ) Sample IDs MUST BE UNIQUE F i-- fz m -- ra s f-- rm ? -- V a lid M a trix C o d e s A-- MATRIX CODE W ATER WT SO IL SL OIL OL W IPE WP AIR AR flS S U E TS O T H E R _________O T WO m m / dd / yy hh: m m a/p t A tk ItS u > Remarks I Lab ID BACK TO Pace Analytical P age C~4 Temp in C: Received on ICE: Y/N Sealed Cooler: Y/ N Samples Intact: Y/N Additional Comments: relinquished By ! Com pany d By / Comparu P is * c s r ___s '/T P 'y /. ' ^ Z tP & S Z --' i s i f SAMPLER NAME AND SIGNATURE PR IN T N am e of SA M P LE R : SIGNATURE o f SAMPLER: S E E R E V E R S E S ID E F O R IN S T R U C TTIOONNS DATE Signed: ( M M /D D /Y Y ) / / A><r> Pace Analytical Services, Inc. Form COC01 02/00 > BACK TO Pace Analytical Page C-5 raceAnalytical / S R e q u ir e d C lie nt In fo rm a tio n : 1 Cqgjoany Address St Section A Phone Fax O !5> f Al Required C lie n t In fo rm a tio n : R eport To: -- r. Invoice To: P.O. Project N am e: ^ M rf. ) 4 * ' t < t-~ f ' Project Nfiimber: CHAIN-OF-CUSTODY / Analytical Request Documenl 574005The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B T o B e C o m p le te d b y P a c e A n a lytica l an d C lie n t Q uote Reference: Section C ~ - = . l, S k r u J ''/ ... f ; : C lie n t In fo rm a tio n (C h ecK q u o te /co n tra ct): R eq ue sted D ue Date: *TAT: ^ T u r n a ro u n d tim e s le s s th a n 14 d a y s s u b je c t to laboratory and con tractual ob liga tion s and m ay result in Rush Turnaround Surcharge. Turn A rou nd T im e (TAT) in cale nd ar days. T .S , Project #: fo f o 5 P ro file Requested Analysis: 3 \ tion D Required Client Information SAMPLE ID O ne character per box. (A -Z, 0 -9 / . - ) Sample IDs M U S T BE U N IQ UE t-rValid Matrix Codes -4---- -- MATRI) . CODE '/ WATER WT SOIL SL OIL OL WIPE WP AIR AR TISSUE TS OTHER OT 1\ Le 5 r Au l >'v f Hy EIm v J P- J AU li? mi k sP L *b l i B S k,x' mp L _ v tiB U EkM i n I k - f i ( < L___i I & yj m 30 |jj 1j hJ k j |f | H I; 8i pj B : ........ i L_ n | v p a ifijl ms j \A j i s ih> K Xi\h J wIS S _ & b ii 11 asv L . _ 11 5 QQL B 1 i W1 MATRIX CODE L 1 DATE COLLECTED izjilw OK 1P re s e rv a tiv e # Containers Unpreserved 2w oiu O 5`i=zl O O W O 2 O 3 0 i%nc> Lhh:mm a/p x 1X X 2 : = ) 1w/ / / / KP JI1 c ., \/ ___ i \ LL i1 1 1 h_1 ii ii Li L1 L -f-- S K 'I 1:! IS1 ~ ~ 1i M1 - 11 \___ fifS S - ---, -- ~1vr ' S ___ "j;r " B 's L j ___ i S _ ___ F* riri1 SLau t ESB Temp in C: ~ rrS PAL& Received on ICE: : Lab ID Sealed Cooler: Samples Intact: Additional Comments: E ate P R IN T Nam e of SAMPLER: / * <J5H -H uif / ATURE of SAMPLER: SEE REVERSE SIDE FOR INSTRUCT! Pace Analytical Services, Inc. Form COC01 02/00 > Required C lie n t In fo rm a tio n : Company Section A / AU Required C lie n t In fo rm a tio n : Invoice To: Project Ni Project N um ber: ICHAIN-OF-CUSTODY / Analytical Request Document 574006The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B T o B e C o m p le te d b y P a c e A nalytica l a n d C lie n t Q uote R eference: Section 0 C lie n t In form atio n (C h e c k q u o te /co n tra ct): R equested D ue D ate: Project M anager: T urn aro gn d.tim es less than 14 da y s sub ject to lab oratory and con tractual o b liga tion s an d m ay resu lt in a Rush Turnaround Surcharge. Turn A rou nd T im e (TAT) in cale nd ar days. Project #: Profile #: Required C lie n t In fo rm a tio n : One character per box. (A-Z, 0 -9 / . - ) Sample IDs MUST BE UNIQUE V alid M atrix C odes M ATR IX i WATER SO IL O IL W IPE AIR TISSU E other Remarksf Lab ID BACK TO Pace Analytical Page C-6 Received on ICE: Sealed Cooler: Samples Intact: Additional Comments: 4 Item No. I R elinquished By Comparr SAMPLER NAME AND SIGNATURE P R IN T N am e o f SAM PLER: SIGNATURE of SAM PLER; DATE Signed: W M M /D D /Y Y ) SEE REVERSE SIDE FOR INSTRUCTIOl Pace Analytical Services, Inc. ' Form COC01 02/00 > XV ^ p flC d A n d ly tiC S l ^ Required Client Information: Section A Address Phone Fax P 5 1 / ^iSi^CHAIN-OF-CUSTODY / Analytical Request Document Required Client Information: Report To: 574007Chaln-of-Custody is a LEGAL DOCUMENT. All relevant fields must be ccoommppleleteteddaaccucurartaetleyl.y. Section B Page: of T o B e C o m p le te d b y P a c e A n a lytica l an d C lie n t Section C Q uote Reference: 7 .S . Invoice To: P.O. Project N am e: f .. ; , Q lien t In form atio n (C h e c k qu ote/cQ ntract): R equested D u Date: *TAT: Project Managen j, S k Turn around tim es less than 14 days subject to P roje ct #: lab oratory and con tractual ob liga tion s and m ay resu lt in a Rush Turnaround Surcharge. ;h u lix H ' Project d u m be r: * a Yf Turn A rou nd T im e (TAT) in cale nd ar days. Requested Analysis: Section D Required Client Information: S A M P L E ID One character per box. (A-Z, 0 -9 /.-) Sample IDs MUST BE UNIQUE I1e La WaIp ^ li k 'J fl r----------------! ValidMatrixCrodest------- MATRI> WATER SOIL OIL CODE WT SL OL LOOU WIPE AIR WP AR ;iCXLi ; --- DATE COLLECTED ' 2 OLU,., {3 LU -. . Pd 8 TISSUE OTHER TS OT 5 - a << hh:mm a/p wm r- R ii h ?O't ~f a \ [ d-X/o tfH S t # Containers Unpreserved I NaOH Preservatives COO X dZX XO O ZCCO01 \ //^ y m 1 ( 11 I Lab ID !c \ Uj p & \ c \ LrVp A ? b r \ fM " rf lfi|i kk 2s ft 2 * _ ki AC-Ai( 4jlA 0 mSfl vmpfi f < I I I 'CT i..C7fi i: 1s 1 If I m I 8 w t l* / ik a V .i |i/-W w Xi P, 1M Sjl A a*? te l 6<Ji 1 * aJ ia i - 1 L ^u : > W ,| f Js * * i "W B B io t li r >5'- <Y; __1yt1 il 5? p ggiSoTlV /yr || pW WSi |g |tj Bl pa :r t i ll 1( \t \l \1 ____L t1 11 \1/ - T /i -5 T , : ; Relinquished By / Company H-jr i r iH i . ww'M ft m i isa |||i Jfl is / v Bi li , , 1* Slu^s pTM " ' r " * " Date Time Accepted By / Company IJij Temp In C: Received on ICE: Y/ N 7 T 5 /P A r f f . n . A ie o c s r y / 'S ? / J>4/ Sealed Cooler: Y/ N Samples Intact: Y/ N Additional Comments: SAMPLER NAME AND SIGNATURE PR IN T Nam e of SAM PLER: /* SIGNATTUUBREE fLSSAAMMPPLLEEIFT Z_ DATE Signed: /(M M I D D / YY) 2-fyfkj SEE REVERSE SIDE FOR INSTRUCT! Pace Analytical Services, In c / Foim COCOI 02/00 BACK TO Pace Analytical Page C-7 BACK TO eO^SsBN Pace Analytical Page C-8 *806Anslyticdl SyRequired C lie n t In fo rm a tio n : Section A H 'S 4 s . /Hbi f- , Al*!A**-* %QQ&j fa&PS CHAIN-OF-CUSTODY / Analytical Request Document 574004The ^ ha'n'of' <' ustody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Required C lie n t In fo rm a tio n : Section B Page: f o f j To Be C o m p le te d b y P a ce A n a lytica l a n d C lie n t Section C R eport To: S> * E U v i c U r 1 O lim p i jnfQ nT)atiQn (C h e c k , q u o tp /c p n tra c t); Q uote Reference: R eq uested D Dat? Project M anager: T . S . C lJ r Project N am e: k ~~ +. . ffl a /j. /.. f-y hoed yfi^rf Project N um ber: 7 T ^ d fn around tim es less than 14 days subject tp 5 lab oratory and con tractual ob liga tion s and m ay resu lt in a Rush Turnaround Surcharge. P ro je ct #: n o *500*1 Turn A round T im e (TAT) in cale n d a r days. Requested Analysis: Section D Required Client Information: S A M P L E ID `I * Is One character per box. (A-Z, 0-9 /.-) Sample IDs MUST BE UNIQUE feValid Mtitrix C odes ------ ^ MATRI> CODE WATER WT SO IL SL O IL O L OoLQU W IPE W P . -X ii- A IR A R CC * QJ S doo TISSU E OTHER TS OT mm / dd/yy Q 2 oLrU P doo hh: mm a/p # Containers Unpreserved j P re s e rv a tiv e s o CD X oz X o X X 9z , ////////// / / / / / / / / /^ R e m a rk s f Lab ID 1( V f i J S k i c--J a fell *__! n 8p n1 ^g| ill; If toff 'IWaS m pi s ii % pT ill ill i * jji |S i Sample Condition J FI 1A qB _ H--r W4MV IMI 1 i J WM "l l k i-o#|-Q---- ... 1 pin: |Jpp ;ir *S; Ife S L/to v ' tej|i K"ill lj|! IS St I it : __ liiA_ Mil___:__ 1 to, j Relinquished By l 1 iSjp HSfifl H |p| . i|2i l'Ifx SIin i g i l l s H H i W|] p i! fc l 7; Agl TTW' i i Ba n pll.-*:ir - Sag I Date !Time | Accepted By / Company i ~ Tl j 1 PS -- M Temp in C: Received on IGE: Y/ N T H F S / P fc t h i& U C T ftn xr -- -5 ^ m /. #' -&'PC tr- Sealed Cooler: Y/N Samples Intact: Y/ N Additional Commente: T A d d r^S A S to * 'S H itc W to S SAMPLER NAME AND SIGNATURE PR IN T N am e o f SAM PLER: / . tWAji) j SIG N ATU RE o f SAM PLER: I SEE REVERSE SIDE FOR INSTRUCTIONNSi DATE Signed: (M M / B D / Y Y) / Y /C Pace Analytical Services! Inc. ' Form COC01 02/00 > BACK TO Pace Analytical Page C-9 L o c ftc - J*aceAnalytical /Required C lie n t In fo rm a tio n : Section A A tjT r e s s flttfp f t - z r r CHAIN-OF-CUSTODY / Analytical Request Document Required C lie n t In fo rm a tio n : R eport Tq_ ~T. S . L U r ; 574009The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B Page: U J . T o B e C o m p le te d b y P a c e A n a lytica l a n d C lie n t Section C Q uote Reference: C jie n t in fo rm a tio n (C h ep k qu o te /cp n tra ct): R guested D ue Date: *TAT: P roje ct M anager: Phone Project N am e: m P ro je c t . % * .. ^ >, f~coo y l^ c ju H M --C - k Turn aro un d tim es less th a n /4 4 d a y s subject to lab oratory arid c o n tra c tu # o b lig a tio n s and m ay resu lt in a Rush Turnaround Surcharge. ^ PPr o jecctts#.: _ . - Oo f *>& 3 Turn A ro u n d T im e (TAT) in cale n d a r days. Requested Analysis: \- J S ectio n D Required C lie n t In fo rm a tio n : SAMPLE ID One character per box. (A-Z, 0 -9 / . - ) Sample IDs MUST BE UNIQUE 4-V alid Meitrix C o d e s ----------- ^ MATRIX CODE W ATER WT SO IL SL O IL OL W IPE WP AIR AR TISSU E TS OTHER OT Il4A s c t f i 1 1 % e Co M il F 6 & >s J & leA "S lu J f i t v b , l e t 8 5 H e A H 1 io 1 " 'i / A >75f f i a fj LU O o X GE fe # Containers ! Unpreserved NaOH ' O -LU ) UOl yrf LU = o o . 2 LU o o mm / d d / y y hh:mm a / p P re s e rv a tiv e ? coo O X O X XX O co M ( I 4s *? *6 ! f t1 V 7 , . m m a O iS! ra s ./" 1 g f. 1 L ab ID a ll t % s i '/C&k \ w, Sample Condition i l 'Mt * i l l a. f ii V- \ > ' ! ' t# Wf/fxi fj i l l " fij--------- m 99 ifUfi Sample Notes item No. Relinquished By / Company Date ill# m/ Wm ip il S m m - T " & ;1 m m i rl:* m WwM p s ;T;>jf USI 1 tIM liai 7 IH S t ' . ji Jig 87 i ml H ?Ai UfE Time ] Accepted By / Company Hi Temp in C: Received on ICE: Sealed Cooler: Y /N Y /N 7 ^ ^ ------ L* Samples Intact: Y /N Additional Comments: PR IN T N am e of SAM PLER: 'S ifa u v l SIGNATURE o f SAMPLER: SEE REVERSE SIDE FOR INSTRUCTIOI* Pace Analytical Services, Inc. Form C O C 01 02/00 > BACK TO Pace Analytical Page C-10 *aceAnalytical Acrarss Phone Fax CHAIN-OF-CUSTODY / Analytical Request Document FL Report To: ,, jr% 574011The Chaln-of-Custody is a LEGAL DOCUMENT. Ail relevant fields must be completed accurately. Page; f / T o B e C o m p le te d b y P a ce A n a ly tic a l a n d C lie n t Section C Q uote R eference: Invoice To: f P.O. Project N am e:, r fiv J V t ' F / Project Num ber: A fa ^ * .* .' / C lie n t In form atio n (C h e ck q u o te /c o n tra c t): R equested D ue Date: k TuEp a ro u n d tim e s le ss th a n 14 d a y s s u b je c t t o _ laboratory an d contractual ob liga tion s an d m ay resu lt in a Rush Turnaround Surcharge. P roject Manager: --r S ' c o i r v i P roje ct #: Q/ o *53-*ycjcPt Turn Around Tim e (TAT) in cale nd ar days. Requested Analysts: S ectio n D Required C lie n t In fo rm a tio n : SAMPLE ID One character per box. (A-Z, 0 -9 / . - ) Sample IDs MUST BE UNIQUE V a lid Matrix C o d e s ------- M ATR I) CODE WATER WT SO IL SL O IL O L W IPE WP AIR AR TISS U E TS OTHER OT X tu Q O O X E 2 DATE COLLECTED QU! w^ UJ H=l 8 hh: mm a/p # Containers Unpreserved NaOH P reservatives O CD o X O XXX O CD to Z ,3 o*<< J/ I S * f e * * : > ffi F- iM U / z OCkS I ns m H m \h L P pi > 1P S m mB S|||| * J S H s r j 5_ m m fkrt*' - > \*s\o u pcL _ Ls imiBME kiP M HRpB|j m > bd U*lL . j y t ; J Jfimlhm * &qB R 5 _ J 1> _ LiB 1 ml-flu 2_ 3 tk i n u l im Sh w 5 _ I G H ed L / tW A m Sample Condition M oo SII F /O /O ]_ I i1 3 1L 1I ;; i 1 || 8 m- L r ^ n J. t: J ii Pr 1L f irrt^: iafix i atte i _l JLl ,, s N \ x fi i I Item No. ; Relinquished By / Company L1tT Li . I Date M .te; rc pi R 3 _m m R ill i? l m im i `\ Prp r ___ ___; a .tejjx liitetei 1 W v?T^'^ tetel ITime ! Accepted By / Company Lab ID Temp in C: Received on ICE: Y/ N Z/OT--T----*-->--f /--p----A----C-----e---.---------------------------------m n in o ,T T /P s t// A n i s- Sealed Cooler: Y/ N Samples Intact: Y/N Additional Comments: SAMPLER NAME AND SIGNATURE PR IN T N am e o t^A M P L E R : . te- 77 U G N A TU R E of SAMPLER: SEE REVERSE SIDE FOR INSTRUCTIOl - ______ Pace Analytical Services, Inc. Form COC01 02/00 > > BACK TO Pace Analytical Page C -11 ~pooO (AhfL<_> J l CHAIN-OF-CUSTODY / Analytical Request Documen raceAnalytical Required C lie n t In fo rm a tio n : Section A Ifot- S /.ogpiy -< ` P,,J? S&o 7 /W Ptcot-A . F L Required C lie n t In fo rm a tio n : Report To: f.S m m r:F c 574013The Chain-of-Custody is a LEGAL DOCUMENT. AH relevant fields must be completed accurately. Section B Page: f o ff To B e C o m p le te d b y P a ce A n a ly tic a l a n d C lie n t Section C Q u ote R eference:. C lie n t In fo rm a tio n (C h eck q u o te /co n tra ct): R equested D ue Date: ` TAT: Project M anager: . ~T. 7 , * Turn around tim es less th a n 14 days sub ject to , laboratory an d con tractual ob liga tion s an d m ay re su lt in i P roje ct#: Oof Rush Turnaround Surcharge. u Turn A round Tim e (TAT) in calendar days. BACK TO Pace Analytical Page C-12 Temp in C: Received on ICE: Y/ N Sealed Cooler: Y/ N Samples Intact: Y/ N Additional Comments: -T fy fP fic te : D h f m rfft&e 0 ^ ---------------------- SAMPLER NAME AND SIGNATURE PR IN T N am e o f S M E LE R : ---- ------------------- ................. . 2 ______ /. S jG j^lA IM R E of S A M P L E R ^ ., fr x^ SEE REVERSE SIDE FOR INSTRUCTIONS ; ifc & M 7n D ATE S ig ne d: , ( M W / D D / Y Y ) * Pace Analytical Services,'Int/ Form COC01 02/00 > BACK TO Pace Analytical Page C-13 Jfv.iY M ) *aceAnalytical Reg ired C lie n t In fo rm a tio n : Com S - S / - PeiJl Agnfess Phone Fax `fj Z ttfQ fc : T ^ sAcou* , f u Required C lie n t In fo r m a tio n : Report To: *X S Invoice To: * P.O. Project N am e: / h: Project N um ber: '- fw HAIN-OF-CUSTODY / Analytical Request Document _ t i 574010The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B _ Q uote Reference: a n d C lie n t Section C SW ' C lie n t In fo rm a tio n (C h e ck q u o te /co n tra ct): R eq e sted D ue D ate: t v' ? Turn aro un d tim es less th an 14 da ys su b je ct t Q a . lab oratory an d contractual ob liga tion s a n d m ay re su lt in Rush Turnaround Surcharge.' 4 .... T u rn A ro u n d T im e (TAT) in c a le n d a r d a ys. Project M anager: ,e T . 5 . C /dr,U < Project #: Ao v P rofile #: . ; ,v Requested Analysis: - , . S e c tio n D Required C lie n t In fo rm a tio n : SAM PLE ID One character per b o x . (A-Z, 0 - 9 / . - ) Sample IDs MUST BE UNIQUE V a lid M atrix C o d e s --- M A T R I> t- * CODE W ATER WT SO IL SL O IL O L W IPE WP AIR AR T ISS U E TS OTHER OT ijj 8 vfi s mo f * i i ' w 0 I f M A M y IO fa fi . T 1l i . i K f i 1 1 : BI 1iSSn ! f i B1i|| 11H18I i f s f| 11|jV.;4m : Vif**`~. Big a ts k ii * fa Ky'.'y Or rP - 3 f f 1 1!i.:0' s na | h *l, t if f - 81 7j Mm MATRIX CODE-^ .3 Q. < *< date COLLECTED Q Hi ty o 2 UJ Pd 0 0 h h :rid m a /p # Containers Unpreserved 1 NaOH P re s e rv a tiv e s , ,4 o CO o z XX I CO co" z 00O A J b% s> :\ r \ y vs ' f-miyir- ? 1f t\ ] , pi 5fit I I I jj IIS a ic I. j a noie Condition % B le Note M >vi Relinquished By / Company Date / W .. . m 'm m M . i if. m p- s p Is# Si f i y ff y,'"ip' H f; ln n i m iff , Ml `f S s i j: &: , y - i 1. ; \ if , Temp in C: Received on ICE: Y/ N ' ~ T F % f'p A U C L sv -* ^ - S s/ Sealed Cooler: Y/ N ' Samples Intact: Y/ N Additional Comments: SAMPLER NAME AND SIGNATURE PR IN T N am e of SAM PLER: /j Lab ID SIGNATURE of SAMPLER: DATE Signed: SEE REVERSE SIDE FOR INSTRUCTION! Pace Analytical Services, Inc. Form COC01 02/00 > BACK TO Pace Analytical Page C-14 Section A^Required Client Information:______ _______ Required Client Information: In voice To: CHAIN-OF-CUSTODY / Analytical Request Document 574014The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B T o B e C o m p le te d b y P a ce A n a lytica l a n d C lie n t Q uote Reference: Section C C fien t In fo rm a tio n (C h eck q u o te /co n tra ct): R equested D ue at: Project M anager: Phone Name: Project N um ber: Turn around tim $s less than 14 days subject to lab oratory an d contractual o b liga tion s an d m ay resu lt in a R ush T urnaround Surcharge. Turn A rou nd T im e (TAT) in cale nd ar days. Project #: P rofile #: 1 # Containers Unpreserved 1 T(ME COLLECTED DATE COLLECTED Section D Required C lie n t In fo rm a tio n -V a lid Mcitrix C o d e s -------------- M ATRI> CODE * i - P re s e rv a tiv e s 1MATRIX CODE ^ SAMPLE ID W ATER SO IL O IL WT SL OL One character per box. (A-Z, 0 - 9 / .- ) Sample IDs MUST BE UNIQUE W IPE AIR TISS U E OTHER WP AR TS OT CO 02 O XXX NaOH d CO 2td^ zr zr 1 3 0 U l.o**<< 1i I .'A IS - i. SI IG rtsL ,-e* O ild o O /( ? /$ \t mi ili m S 41r r is t pJfH i r) L v 1s! & L s p e a 0 , VK r 8hI \ ; tr4 v pii<-> IR TW tS a - . -L(LL1 L^"A"t.|C1LLSK,Wl*.*it|sInStmt#i'LtfpIii l V. i igag |K MlM l11i5lPi? A/}/' a ft gf^S l|| 'S i t |.ft Bk a - 1MtU i* IS-s X' ft LvviJ2 : \1 lff\ ! . j i< ':v s \\ m \m \t \[ P B ip \( "T \\ & . . . Ili S 1 f\ ;1 v' ftSpl'X--H--B s f yIs 111 1* - V t T iw!f i u - f c \ Xj \ \ S ili w tfs "' c-V S f|i|| Jill nquished By / Corn party Date ITime j Accepted By / Company T e mp i n C: f Moo" 7 Tf--P A // .----*------------------------------5------------------ ----......... ^ R eceived on ICE: Y/N S ealed Cooler: Y/ N S a m p le s Intact: Y/N Additional Comments: SAMPLER NAME AND SIGNATURE P R IN T Nam e o f S A M P LE R : 's// "---- -------- 1 Lab ID $r SIGNATURE of SAM PLER: SEE REVERSE SIDE FOR INSTRUCTION Pace Analytical Services, Inc. Form COC01 02/00 > BACK TO Pace Analytical Page C-15 filbtjH sAS CHAIN-OF-CUSTODY / Analytical Request Document 'aceAnalytical p u - t 574015The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. SgCtlOll ARequired C lie n t In fo rm a tio n :________ __________ Required C lie n t In fo r m a tio n : Section B To B e C o m p le te d b y P a ce A n alytica l an d C lie n t Section C Q uote Reference: :"3 t - > / . Aamgss D uJU RS T% . X W Invoice lb : ' r .M d ? ' ' 5 ' C lie n t In form ation, (C h e ck q u o te /co n tra ct): R equested D ue Date: Project M anager: Phone Fax P.O. Project Nam e: ,. w * ii' c ./v Project N um ber: ' ...- i--,* 3T x t e d r * r i'/ / T urn around tim es less th an 14 ela ys subject to lab o ra to ry a n d co n tractua l ob lig a tio n s-a n d m ay resu lt in a R ush T urnaround Surcharge. Turn A rou nd Tim e (TAT) in calendar days. Project #: P rofile #: Requested Analysis: S e ctio n D Required C lie n t In fo rm a tio n S A M P L E 1D One character per box. (A-Z, 0 -9 /.- ) Sample IDs MUST BE UNIQUE - m i .: w U life 'i, VJg j | 4V a lid Me trix C o d e s --------- -- _ M ATRIX CODE W ATER WT SO IL SL O IL O L W IPE WP AIR AR TISS U E TS OTHER OT te i 1 S : /Jd : m i` pu LU OQ O X oc ,3 3 a a < *< DATE COLLECTED n fu lu o QOO f I s3-3 30 G TIME COLLECTED # Containers | Preservatives -(oD t(b CO) 3QC. d CO X oz X o X d X ozcd d zCO 1J 11 Up m !f5T li J l tid M m l A 1 1 : 3 4M 1 l i >4 fk r J $ ____ I I I t1 j iL / 1T J n m 82 k W s it ' J K H ^ 'S iU S IB 131 S : S B lik t e < V $ k .y m Ns rp 1i : r: P- i S fe iv " SW -- t W jg s M m m * ijp & t M jjd W&wt w w T 5 i ~T~ 1 11 [ XX 1i ^p -------- B r f i --------- i f t m * ------- ------------------- 1 1X L m if JL - I 1---------------- L -- - Item No. j Relinquished By / Company M M IS SI _ spi gg| _ WS? R -- Ifj? p B -- -- - -- - Date Ilim e -- ------ _ -___ !Accepted By / Company -- ti iS ft !^ P S ti 1 S I 1 La b ID Sealed Cooler: Samples Intact: Additional Comments: 4 ~t: SctimuD:PRINT Name of SAMPLER: N A T U R E o f S A M P L E R ;.... , SEE REVERSE SIDE FOR INSTRUCTION! DATE Signed: /( M M /, D D /Y Y ) Services! Inc. Form COO01 02/00 > BACK TO Pace Analytical Page C-16 weAnalytical i ^ r r Required C lie n t In fo rm a tio n : SGCtion A C lie n t In form atio n: CHAIN-OF-CUSTODY / Analytical Request Document 574016The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B To B e C om p le te d b y P a ce A n a lytica l a n d C lie n t Section C Address In vofce To: r / v"'' . . . C lie n t In fo rm a tio n (C h e ck q u o te /c o n tra c t): *\. P rojct Manager: Phone Fax P.O. Project Nam e: M & ifi Project N u m b e r^ : \ ^ ...... jfc&dt -Sh^elfy .1 / * Turn around tim es less than 14 da ys su b je ct to lab oratory and contractual ob liga tion s an d m ay re su lt in a ,R ush T u rna rou nd Surcharge. T urn A rou nd T im e (TAT) in ca le n d a r days. Project #: P rofile #: Requested Analysis: I Section D Required C lie n t In fo r m a tio n : S A M P L E ID One character per box. (A-Z, 0 -9 / .-) Sample IDs MUST BE UNIQUE V a lid M a trix C o d e s 4------------- ' t M ATRIX W ATER "/ CODE: WT sl X LU Q O O E Jp :X " ' DC TISSUE TS other ot date : COLLECTED LQU 2S^Ioli Hd OO h h :m m a /p # Containers 1P re s e rv a tiv e s T<JD xtCODT Q. C. OCO O Z O O X OCtJ CO te1 => X X 2 .Z 3 1 A ,h &/01 k m u in ra j Q J lJ V ? w 6 1 i V/T: P s fi I |\ - |jj^ J 111 S w; ' \r _i -m m -\ -K P tM Kt vfZ p P 'i ; < Ifc i j l %i l s-fav.vB<? 5lu ii> -1/ i 4 t J -- fed H t/ P ' i 0 - j I : yu ) C l'v '' JU v Ljl _, ( BL-. P (p :K l k l i 7 )ilU a ,L % ^.jpg Ut ft |w H n * l l y ] B H JB! 5 8 B '. lia .. S / ~-- f-- / y :-- J i r i iI A 1i r i1 i1 T l J1 TJ4 i P J1 /, 1 J . 1 X . 1 L. _ S I S | -- B ~ SS _ -- ; jasr M B i _ --, __ _ S I S1 oe SS T 8 _ :__ A ccepted By / Ci Temp in C: T T i fp firL tz - L QfW - f Received on ICE: Y/N Sealed Cooler: Y/N Samples Intact: Y/N Additional Comments: SAMPLER NAME AND SIGNATURE S _ / y f/ /t Lab ID nr UGNATURE of SAMPLER: SEE REVERSE SIDE FOR INSTRUCTION: DATE Signed: Pace Analytical Inc. Form COC01 02/00 > BACK TO Pace Analytical Page C-17 4ceAnalytical Required C lie n t In fo rm a tio n : Section A Address AJ/U CHAIN-OF-CUSTODY / Analytical Request Document ^ T' ^uce; ^ ^ 574017The Chain-of-Custody is a LEGAL DOCUMENT. A ll relevant fields must be completed accurately. Required C lie n t In fo r m a tio n : Report fo g Project N am e: ,. '( ft ? Section B -3:cLC lie n t In fo rm a tio n (C h e c k q u o te /c p n tra c t): R equested D ue Dat: M u m g ro un d tim es (ess th an 14 da ys sub ject to , lab oratory a n d con tractual ob liga tion s and m ay re su lt in a / , | R ush Turnaround Surcharge. * . 9 h d i y Turn A round Tim e (TAT) in calendar days. T o B e C o m p le te d b y P a ce A n a ly tic a l a n d C lie n t Q uote Reference: Section C Project M anager: .I ^ < ^ A A ijrh e P roje ct#: 'W ^ / j * irf< r3 < r ff= 7 Profile #4^ T T ./ Requested Analysis: Sction D Required C lie n t In fo rm a tio n : V alid M atrix C od es * W ATER WT SAMPLE ID SO IL SL O IL OL One character per box. W IPE AIR WP AR (A-Z, 0 -9 / . - ) Sample IDs MUST BE UNIQUE TISS U E OTHER TS OT m S5 kx 1.J v p C t1 _ s S S_ EE> HHE J I L 8u Hmi( 1 w L. *c M ' L_ ; 1 P1 i B L. _ L t d && k r m M a s 1 1L i I t ! b$ =dj 7- E 1IS_1t s 1 ft zV it > E \h Jj s a oCrL i r H 1_ S n-- _ wc dis _V mmp 6 Si n1 s y mJ"'i _ 3a L - bibb. . -ZJ ISS.$ij 51' pfi _ _ "..*-- .. _ --- - Temp in C: Received on ICE: Sealed Cooler: Samples Intact: Additional Comments: MATRIX CODE # Containers Unpreserved NaOH 5S o LU !SOUJ zoi F do OO mm / dd / yy r' hh:mm a/p &O J O Ow d Z O X XX CO 'Z. / / ^ ^ ^ / / ^ ^ /^ / ^ ^ ^ / ^ R e m a r k s ; L a b ID T7T1 ?Zpp wm is TBTSvl i T* f rMi j";1"/' ~ r 11 LX1 1 &r p' iS f ' . fe_L M1: fSRt "ZX / WiNr 1 r 7B~ ` n1"T" 1-~--- rm? :Z; im,icai.va: '0;:g P U #5 Yrrr? S" -- _ T* p feb *' r y' H )ate I Time j Accepted By / Company `&i P'R IN T N a m e of S A MM(P LE R : SUIGGNN;ATU R E o f S A M P S E E R E V E R S E S ID E FO R IN S T R U C T! DATE S ig n e d y ( M M / D D / Y Y ) r& n fo PaceAnalytical Services, Inc. Form COO01 02/00 > BACK TO Pace Analytical Page C-18 raceAnalytical C^XX'MfgVkS, i?A e Required C lie nt In fo rm a tio n : Company ^A t Address v - Q X. S S C tiO T I A ir t i ) \c C lie n t In form atio n: R e p o rt^ In vo W T o : .. * t - P.O. Phone Fax 7m r Project N um ber: ir , j f CHAIN-OF-CUSTODY / Analytical Request Document 574018The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. To B e C o m p le te d b y P a ce A n alytica l a n d C lie n t Q uote Reference: Section C Q lie n t In forrrtQ tjon (C h e c k q u o te /c o p tra c t); R equested D ue D ate: *TAT: Project M anager: > f .: w T urn around tim es less than 14 da ys su b je c t to lab oratory an d c on tractual ob liga tion s and m ay resu lt in , R ush J u m a ro u n d Surcharge. n d Iflm e (TAT) in ca le n d a r da ys. ^ Project #: P rofile #: .; s e r v ie I Section D Required C lie n t In fo rm a tio n V a lid Mitr ix C o d e s -- -- M A T R IX CODE ; Q Lit LU P re s e rv a tiv e s MATRIX CODE # Containers Unpreserved NaOH SAMPLE ID One character per box. (A-Z, 0 -9 / . - ) Sample IDs MUST BE UNIQUE * io p a *k . H i fIp f 4 iP J g k -W V y 1 IS vi 1 hi L *N 4 P f * JM u S i L bi wj 6 S| w _ 6 j fo<A g jB i (Ul-^ 1 JI 1V ill m M J A WATER SO IL O IL W IPE AIR TISSU E OTHER W, L ||| rS~ ilf: ;:'f \ Jifl WT SL OL WP AR TS OT _ Musi I B -- 1 3 m E5 !ILI Q =1 Oo 2 LU i==j o O mm / dd / yy hh:mm a/p d OT O Z O XXX O CD Z D -h lo -- f-- f------ j I ~T~ 7 Xx 1X x Tx "Ti--x 4.i tI - P gl j ---- *- g M im M B Ws i X jM ft -- * m B _ -- |l|j w liS A m p f. ' r -ut 1 J B s_ y lix ,, MT7 B Sit L I-'X T s y UY3 6 UI I I _ LlCf1 ^|p |i ; |pi g L , jp L y. P Itt 3 ljjj >fll v W s SP tfli; pMi 1IS N 1i 1X , . 11 n 1 .1 1L m8 .7?& S ? pi _ 777 n" Wm- ^y~sr. 'A m f m AM -- * 3i if Sm ililtii --I m '-- 7X1: r. no. ; relinquished By / Company I Date ITime | Accepted By / Company Temp in C: Received on ICE: rfrr |M pli s J ft X7rX- WA wi 4: 9m Lab ID Sealed Cooler: Samples Intact: Additional Comments: SAMPLER NAME AND SIGNATURE I PR IN T Nam e o f S A M P L E D 1 ^T 7 S IG N ATU R E of S A M P LE R r" O- u fi *'* *-^ SEE REVERSE SIDE FOR IN STFtU ifeN ^ " 1 /D A TE S ig n e d : . ( M M / D D Y Y ) f^ h /r j Pace A n a iy fe f^ jv ip e s , Inc. ' Form COC01 02/00 > BACK TO Pace Analytical Page C-19 6k fiifV ^ ''' * ' ^ / J ^ ac e Analytical >A Required C lie n t In fo rm a tio n : Company ~^U Section A \ h t .. R e q u ir e d C lie n t In fo rm a tio n : R ep ort To: CHAIN-OF-CUSTODY / Analytical Request Document 574019The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B To Be Com pleted by P ace Analytical and Client Q uote Reference: Section C C lie n t In fo rm a tio n (C h e c k q u o te /co n tra ct): R equested Du D ate: ^TAT: Project M anager: >1 Phone l / 4-t C ?4 y P ro je c t N uummbbeerr:: T? * * T urn a ro u n d tim e s Less th a n 1 4 d a y s s u b je c t to la b o ra to ry a n d c o n tra c tu a l o b lig a tio n s a n d th a y re s u lt in a l u s h T u rn a ro u n d S u rc h a rg e . ; , Project #: /A ro u n d T im e (T A f) in cale nd ar days. RequestedAnalysis: S ection D Required C lie n t In fo rm a tio n : V a lid M atrix C o d e s 4 - --------- M ATR I) CODE SAMPLE ID WATER SO IL O IL WT SL OL QLU OO One character per box. (A-Z, 0 -9 /.- ) Sample IDs MUST BE UNIQUE W IPE AIR TISS U E OTHER WP AR TS OT X DC M 1 bl Id 1 lM sT J . J s_ 6 |^ sf | ( 1 ft < SJ LWbp11|L' - V ') -mK i l l ; k : V 1 c _ J <>yU * 1 li*f| 11 PS itip V telIs . LJ A I 1> 2 C,-peLu tv. La ih k< t hf- ,8 * 1 1B ^ -j MSMy v 'jamdir rr fg gig -v fell m PS f - : F ii Sii : tPi l SIS l : k l jIl & ' Y Y liSlj XT__W | Y vsv-is; % U ^V .v h *1l]_L ;* L ? l < Ivn T- i* p S /X e JSi; jl l- is IP Fa M f i Temp in C: Received on ICE: Sealed C ooler: Samples Intact: Additional Comments: LU < UJ =oo| mm / dd / yy & h fw > A 1------ Ct LU L2UUJ p =ool hh:mm a/p # Containers Unpreserved 1 P re s e rv a tiv e s CoO oz XX o X $ o zCO :` 0o 1( i 1 \ {1 \ i\ \\ ii \1 . /\/ p|t 1H it M 3 W P ISI s m- .;fIl ' fte| . Sl 'I'i- H -- S ffi ip l jgp# l I pted By / Company SAMPLER NAME A N D SIGNATURE p if iS ' ' k PI msi? -- fi 1 L a b ID te I Time SEE REVERSE SIDE FOR INSTRUCTIO DATE S igned: (Mfyl / DD / Y Y ) vices, Inc. Forrnm COC01 02/00 > BACK TO Pace Analytical Page C-20 (U faceAnalytical '__c. R e q u ire d , C lient In fo rm a tio n : Section A Company " ^jU Address .. S j. (tuA iU n Phone Fax CHAIN-OF-CUSTODY / Analytical Request Documenl 3 ( GiA 574020The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be coinpleted accurately. Required C lie n t In fo rm a tio n : Section B Page: ^4 T o B e C o m p le te d b y P a ce A n a lytica l a n d C lie n t Q uote Reference: Section C Client Information (Che<ai quote/contraot): In v o ic & T o : 7^ R equested D ue Date: *TAT: Project M anager: At P.O. Project N am : ^ > - I * Turn arouncfttraies less than 14 da ys sub ject to lab oratory an d contractual ob ligations and m ay result in a Rush Turnaround Surcharge. Project #: a J n l 4 - t f F -o f i w v i ~ d ~ ir ') i / P roje ciN u m b er: 1 | Turn A rou nd T im e (TAT) in cale nd ar days. Requested Analysis: DI Section Required C lie n t In fo r m a tio n AV a lid M atrix C od es ------ M ATR I) CODE illQ Q Preservatives L # Containers Unpresen/ed NaOH SAMPLE ID W ATER SO IL O IL WT SL OL LU Q O 5 iu o =i 2 LU Pd One character per box. (A-Z, 0 -9 / . - ) Sample IDs MUST BE UNIQUE W IPE AIR TISS U E OTHER WP AR TS OT X or O u o o m m / dd / y y h h : m m a / p do Zo X 1X X q CO Xcc1 f ?X L y , JM X 4: VA j, h-- j i n IA V-`r i p- ig t 1X 1m p i * k L pbj 1m |j _LM G HjMmkPu*'S1 1 Bll e t |J|SJ H3 M 7 B 5 till [ if- L 1 kii!u`bpd X I k bon X l dxm2 1 X c 8 B M t T L* 9 id |||-L 4 J l n ist e1JLoei*^bdIrsSjHED8P|Si;S!L.i i 2 rs mmanJxZ fi* Tp~' 2 P fra ___ i 8 J1lgf pii sm m 0. j'i -v - k -- H m. i mSili \U io o nr il3 < ? } 1A _L 1 G/ j 11 1 1 i. i i1 A1 J) .4' 1 t1 \ A1 i 1 i; ----------- " -------------- f-- 2r I -VXDj, U "T m V1 --S * k 2 K rb . -- i 13 tW0em WXk Mg m S8|S ! Lab ID 1 oasnpie Cotiditon Temp in C: Received on ICE: Y/ N Sealed Cooler: Y/ N Samples intact: Y/ N Additional Comments: C i . " v 'o M e tt:. fi * item No. Relinquished By / Company Date Time Accepted By / Company Dare y -----X---- *%^ xr ----w--------x---------- 4/ -- k ^ h ----c---==e-^-----------s--u---f1--a t / a ? ) ( i f f { ? < >t *r -------------------------------------------- ---*--------- ----I-t--------- r:---- ----------------------- *A -- --------------------------- ------ ---- ---- > f 4 " . --- ----------- !. 2 ' ' -------------------------- -------------- -- ------------- X -- ............ SAMPLER NAME AND SIGNATURE P R f ^ p N a m ^ o f -SA M p L E Q ^ ^ - r - -- ------- ' .-- / " ^-- /* ------------------------ of SAMPLER: SEE REVERSE SIDE FOR INSTRUCTION D /ffB -S ign ed : M M l DD / YY) iu .h fo O Pace Analytical Services, Inc. ' Form COC01 02/00 > / "B i ' ^aceAnalytical CHAIN-OF-CUSTODY / Analytical Request Document 574021The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. T o B e C o m p le te d b y P a c e A n a lytica l an d C lie n t Section C BACK TO Pace Analytical P age C-21 Sample Concm en Temp in C: Received on ICE: Y/ N Sealed Cooler: Y/ N Samples Intact: Y/ N Additional Comments: : 1-2 ' k -: . 1` em ;i:;. Relinquish*.-d By / Com pany ,p.'; ' H SEE REVERSE SIDE FOR INSTRUCT! Date Time | A ccepted By / Company & / / / 'c**r* \-! SAMPLER? _ - _ ... - _ ef. // ' Date /. <r r r \\ m____t- . - i DATE Signed- (m W d D /Y Y ) 'a / Q _______ Pace Analy5caTirvices, the. ' Form COC01 02/00 > taceAnalytical ilr e d C lie nt In fo rm a tio n : ^A ffire ss . St Section A h h u ,l /A//J R e q u ir e d C lie n t In fo rm a tio n : R eport To: In v o ic e lo . ^ P.O. Phone Fax Project N am e: i1 .4 * Project N um ber:^TM CHAIN-OF-CUSTODY / Analytical Request Documenl 574022The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B T o B e C o m p le te d b y P a ce A n alytica l a n d C lie n t Q uote Reference: Section C C lim at In fo rm a tio rU C h e c k q u o te /c o n tr^ c t): Project M an ag er - C+r A _> t U t- ' * T urn a ro un d tim e? less, than 14 days subject to laboratory and con tractua l ob ligations an d m ay resu lt in k ; Rush Tum aroundiS urcharge. tu r n A rou nd T im e (TAT) in ca le n d a r days. P roje ct#: Profile? # : R eq ue sted A n a lysis: y** " / Section D R e q u ir e d C lie n t In fo rm a tio n : One character per box. (A-Z, 0 -9 / . - ) Sample IDs MUST BE UNIQUE V alid M atrix C odes M ATR IX Q W ATER SO IL O IL W IPE AIR TISS U E OTHER Vj-LU m m / dd / yy hh: m m a /p #6 Rem arks' Lab ID BACK TO Pace Analytical Page C-22 Temp in C: R eceived on ICE: Y / N, Sealed Cooler: Y/ N S a m p le s Intact: Y/ N Additional Comments: io. I Relinquished By / Company C o ----- >< lar . - : y 1f-- J *- \ L / /i . y ... A i r ' f SAMPLER NAME AND SIGNATURE P R IN T N am o o f S i ^ P LE R j-- ~T... hcH*tV>7 SIG N ATU R E of SA M P LE R: ^ S"SEE REVERSE SIDE FOR INSTRUCTIO -y -- DATE Signed: (M M D D / Y Y) / > /?* /% - > " ace Analytical Services, Inc. Form COC01 02/00 > BACK TO Pace Analytical Page C-23 / % raceAnalytical r, C om pa ny _____ v : ------- ^ > IU Address - ftu b \ . . fJ U 7 Report To: % Invoice To: i s -v o y * / CHAIN-OF-GUSTODY / Analytical Request Document 574023The Chain-of-Custody is a LEGAL DOCUMENT. All relevant Helds must be completed accurately. Page: I 4 SGCtlOn CTo Be Completed by Pace Analytical and Client Q uote Reference: Client Informatioji (Check quote/contract): R equested D D te: "TAT: Prefect M anager: Phone P.O. Turn around tim es less than 14 day? subject to P ro je ct #: N laboratory an d con tractual ob liga tion s an d m ay result in a Project Nam e: ....... Rush Turnaround Surcharge. ..." P rofile #: 1 J i f i Q n ro i Turn A ro u n d T im e (TAT) in c a le n d a r d d y s . yFax 4 o je c t Num ber: ^ 'f ( ^ Requested Analysis: Section D Required Client Information: SAMPLE ID One character per box. (A-Z, 0 -9 / . - ) Sample IDs MUST SE UNIQUE raw B S B ff-- te e ? a: I m ^ i V a lid M a trix C o d e s -- MATRIX CODE W ATER WT SO IL SL O IL OL W IPE WP AIR AR T ISS U E TS OTHER OT Sr n Tm n 11mi l l s~ IS 11 MATRIXCODE-^ 1 date - COLLECTED vVcC OHI w5 oLU F=Ood hh.mm a/p n jz lv o tlo # Containers Unpresen/ed HCI NaOH I Preservatives oCD o X, X X \' o Z.S1 ____l____ ? 1 l! t Xi e i: i t . mt c 1;!'i i 1 f&l ft i 1m 1% L - t : SP L -;pSvI 1 -- _ -- 41 j i " tsiinquished By / Company !5 T Temp in C: Received on ICE: _____________________________< q Y/ N jH-cki m rb tj) >>/ Sealed Cooler: Y/ N -- \c r/r- T /j / / JT Samples Intact: Y/ N Additional Comments: PR IN T N am e of S A M P E R : / V > tH W i5 T ____________________ SIGNATURE of SAMPLER: "T DATE Signed: (M M / D D ^Y Y ) 1 - ts 3 x S g *~ - ii.i l ..... : ________ / - / $ / & (j >