Chain of custody form, 90 Church Street, Nov 2001

NYC 9/11 Public Portal Document

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LOT RECEIPT CHECKLIST STL Sacramento

CLIENT y -~GfkL PM- ~ LOG j, (Z{ Le

LOTS (QUANTIMS ID) L ']h ) QUOTEI _LOCATION' _ k,.~t ./

Initials Date DATE RECEIVED --Z -o TIME RECEIVED ___J _____ 1#~!~ DELIVERED BY p-FEDEX ❑ CA OVERNIGHT ❑ CLIENT ❑ AIRBORNE ❑ GOLDENSTATE ❑ DHL ❑ UPS ❑ BAX GLOBAL CO-GETTERS ❑ STL COURIER ❑ B .& B ❑ OTHER

CUSTODY SEAL STATUS ❑ INTACT ❑ BROKEN ) N' /A CUSTODY SEAL I(S) SHIPPPING CONTAINER(S) ❑ STL 4ØCLIENT ❑ N/A TEMPERTURE RECORD (IN °Q IR 1❑ 2, ❑ OTHER COCA(S) TEMPERATURE BLANK e AMBIENT TEMPERATURE COLLECTOR'S NAME: 2 Ied from COC "Not on COC

pH MEASURED ❑ YES ❑ ANOMALY .•~'iV/A LABELED BY............:............................................................................. LABELS CHECKED BY........................................................................... SHORT HOLD TEST NOTIFICATION SAMPLE RECEIVING WETCHEM JfWA

❑ METALSrNOTIFIED OF FILTER/PRESERVE VIA VERBAL & EMAIL 21 N/A

COMPLETE SHIPMENT RECEIVED IN GOOD CONDITION WITH ❑ N/A APPROPRIATE TEMPERATURES, CONTAINERS, PRESERVATIVES ❑ Clouseau ❑ TEMPERATURE EXCEEDED (2 °-6 °0 N/A. ❑ WET ICE ❑ BLUE ICE ❑ GEL PACK ❑ PM NOTIFIED 0 NO COOLING AGENTS USED • Notes:

NO SPACES BLANK. USE N/A' IF NOT AA LIC SLE. IN ~1~ 3 AALL'WA ENTRIES. GA185 8100 NEK G1J27013 Sot 51 NYC-WTC 000124852