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
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