NYC 9/11 Public Portal Document
PSC Analytical Services
Sample Receipt Checklist
Client Name ATC ASSOCIATES Date and Time Receive 10/10/2002 9:50:00 AM
Work Order Numbe R02100360 Received by NAG
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Checklist completed by ~!)1~/6 L Reviewed by Lb/V ~1
S store ` oa~e w~ia~s oat
Matrix: Carrier name FedEx
Shipping container/cooler in good condition? Yes ivi No! .1 Not Presen ❑
Custody seals intact on shippping container/cooler? Yes L. No Not Presen
Custody seals intact on sample bottles? Yes 1. 1 No Li Not Presen W
Chain of custody present? Yes No. 7
Chain of custody signed when relinquished and received? Yes I 1 No U
Chain of custody agrees with sample labels? Yes 1 1 No ..i
Samples in proper container/bottle? Yes Fi! No
Sample containers intact? Yes X11 No
Sufficient sample volume for indicated test? Yes h/! No . 1
All samples received within holding time? Yes V No I .~
Container/Temp Blank temperature in compliance? Yes I No : .1
Water - VOA vials have zero headspace? No VOA vials submitted L/I Yes Li No L I
Water. pH acceptable upon receipt? Yes No
Adjusted? Checked b
Any No and/or NA (not applicable) response must be detailed in the comments section be
Client contacted Date contacted: Person contacted
Contacted by: Regarding:
Comments:
Corrective Action
C7
NYC-WTC 000130045
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