Chain of custody form, 90 Church Street, Nov 2001

NYC 9/11 Public Portal Document

LOT RECEIPT CHECKLIST STL Sacramento

CLIENT PM LOG #

LOT# (QUANTIMS ID) QUOTE LOCATION

Initials Date DATE RECEIVED 'O TIME RECEIVED "13 ~Q~ f

DELIVERED BY EDEX ❑ CA OVERNIGHT ❑ CLIENT ❑ AIRBORNE ❑ GOLDENSTATE ❑ DHL ❑ UPS ❑ SAX GLOBAL ❑ GO-GETTERS ❑ STL COURIER ❑B &B ❑ OTHER

CUSTODY SEAL STATUS [] INTACT ❑ BROKEN /A CUSTODY SEAL #(S) SHIPPPING CONTAINER(S) ❑ STL 4ZJCLIENT ❑ N/A TEMPERTURE RECORD (IN °C) IR 1❑ . 2Z1 ❑ OTHER CDC #(S) TEMPERATURE BLANK AMBIENT TEMPERATURE _ r COLLECTOR'S NAME: ❑ Verified from COC jot on COC

pH MEASURED ❑ YES • ❑ ANOMALY )ZI'N/A

LABELED BY.......................................................................................... LABELS CHECKED BY........................................................................... SHORT HOLD TEST NOTIFICATION SAMPLE RECEIVING WETCHEM A

❑ METALS NOTIFIED OF FILTER/PRESERVE VIA VERBAL & EMAIL ja"N/A

❑ COMPLETESHIPMENT RECEIVED IN GOOD CONDITION WITH A APPROPRIATE TEMPERATURES, CONTAINERS, PRESERVATIVES 2 10oUSeaU ❑ TEMPERATURE EXCEEDED (2 °-6 °C) ❑ N/A ❑ WET ICE ❑ BLUE ICE ❑ GEL PACK NOTIFIED ❑ NO COOLING AGENTS USED

SAVE NO SPACES BLANK. USE 'WA' IF NOT APPLICABLE. INITIAL AND DATE ALL'N1A ENTRIES. QA185 8100 NEK 31J27013 STL - Sacramento (916)373-5600 6 of 47

NYC-WTC 000124803