NYC 9/11 Public Portal Document
• PSC Analytical Services
Sample Receipt Checklist
Client Name ATC ASSOCIATES Date and Time Receive 9/17/2002 10:30:00 AM
Work Order Numbe R020 05 Received by DMT
Checklist completed by
s,pnuua Dal
Reviewed by \ Yd
Matrix: Carrier name FedEx
Shipping container/cooler in good condition? Yes h/l Noi Not Presen
Custody seals intact on shippping container/cooler? Yes L. No ,. .l Not Presen
Custody seals intact on sample bottles? Yes No — Not Presen
Chain of custody present? Yes I No _j
Chain of custody signed when relinquished and received? Yes ' No L.
Chain of custody agrees with sample labels? Yes 1 ' No
Samples in proper container/bottle? Yes U No Li
Sample containers intact? Yes O No
Sufficient sample volume for indicated test? Yes W No
• All samples received within holding time? Yes 1i1 No El
Container/Temp Blank temperature in compliance? Yes Iii No U
Water. VOA vials have zero headspace? No VOA vials submitted lJ Yes I. No',
Water. pH acceptable upon receipt? Yes Li No
Adjusted? Checked b
Any No and/or NA (not applicable) response must be detailed in the comments section be
Client contacted rQ )U f JTDate contacted:
5 `7 Person contacted FrQ U ('l CIA( ST
Contacted by: Regarding: l~ ISS t h s (Jv+t <.. ~- C gfi Q .S
Comments. fY- -)
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Corrective Action O G3
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NYC-WTC 000130062
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