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Chain of custody form for indoor air quality survey at

Machine-extracted title · confidence 95%

Documentation tracking the collection and handling of samples during an air quality survey at the specified building.

NYC-WTC_000108401–000108573

Folder label: “45 JOHN STREET; Block: 78 Lot: 28 BIN: 1001199 1-5 Dutch Street

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Scanned page image, NYC-WTC_000108476
OCR text

OCR status: ok · source: pdftotext

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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NYC-WTC_000108476Source: NYC Law Department, mirrored locally

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NYC-WTC_000120991 · Box DEP Box 48

Record documenting the transfer and custody of air samples from Building #100 at 345 South End Avenue collected on October 22, 2001.

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