600 S. Wagner Road Ann Arbor, MI 48103 LEAD CHAIN OF CUSTODY 600 S. Wagner Road Ann Arbor, MI 48103 877-220-3528 | info@pellabs.com Page 1 of For Lab Use Only Lab No. Accept Reject Contact Information Project Information Report Results (Check box) Company: Phone: Project Name: Contact: Cell Phone: Project Location: Email Account #: E-mail: Project ID: Other Sampled By: Name: Date: P.O. Number: RELINQUISHED BY DATE & TIME VIA RECEIVED BY REQUESTED SERVICES (Please Check the Appropriate Boxes) No. Sample ID (10 Characters Max) Sample Description Volume (Liters) Volume Area (Length x Width) Sample Matrix (see matrix code box) Analysis Units (Check ONE box only) Sample Matrix Codes Pb PPM Wt % mg / l µg /ft2 µg / m3 mg / cm2 A Soil B Paint Chips C Surface / Dust Wipes 1 D Bulk Miscellaneous 2 E Air Cassette 3 4 5 6 7 8 TURNAROUND TIME 9 Same Day 10 24 - Hour 11 3 - Day 12 5 - Day

600 S. Wagner Road Ann Arbor, MI 48103 LEAD CHAIN OF CUSTODY 600 S. Wagner Road Ann Arbor, MI 48103 877-220-3528 | info@pellabs.com Page 2 of For Lab Use Only Lab No. Accept Reject Project Information Company: Project Name: Project Location: REQUESTED SERVICES (Please Check the Appropriate Boxes) No. Sample ID (10 Characters Max) Sample Description Volume (Liters) Volume Area (Length x Width) Sample Matrix (see matrix code box) Analysis Units (R ONE box only) Sample Matrix Codes Pb PPM Wt % mg / l µg /ft2 µg / m3 mg / cm2 A Soil B Paint Chips C Surface / Dust Wipes 13 D Bulk Miscellaneous 14 E Air Cassette 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30