Chain of custody form for indoor air quality survey at

NYC 9/11 Public Portal Document

Galson Laboratories Corrective Action Log

IH Sample Receipt /Login Client Name: Date Received: ( o b

Client Contact: 1 O(:oS Login #: L2CQ '7 ' '(D

All of the samples are affected. Some of the samples are affected; list the samples below.

1 Client ID: Analyte: Client ID: Analyte:

I ____ ___ ____

I Check the item(s) below which best describes the problem and/or observation noted for the samples.

Sample integrity compromised (tube broken / filter torn) Solution spilled and / or leaked I Unable to read Client Ids Samples received unrefrigerated

Client Ids don't match Chain of Custody Improper collection media

M labels detached from samples Incompatible analyses

Asbestos samples received wet / satura ed Unable to perform method requested

Other: k- r e ~

I

Project Manager: r U 9M I

I Has Client Been Notified?

____ 4 l NO Date / Time:

Action To Be Taken:_j

I QIFc1

Action Completed:

QA/QC:

MAINTAIN ORIGINAL IN CLIENT WORKORDER FILE COPY APPROPRIATE GROUPS. COPY TO LAB MANAGER

I Approved by: Lvndi W. Motf Date: 4/12/01 Form: LQ6 / rev. 0 Issue Date: 11/99

I NYC-WTC 000108476