NYC 9/11 Public Portal Document
PSC Analytical Services
0 Sample Receipt Checklist
Client Name ATC ASSOCIATES Date and Time Receive 10/11/2002 9:45:00 AM
Work Order Numbe R02100418 Received by HG
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Checklist completed by ;'~
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Matrix: Carrier name Feder
Shipping container/cooler in good condition? Yes V No ❑ Not Presen ❑
Custody seals intact on shippping container/cooler? Yes ~ No ❑ Not Presen
Custody seals intact on sample bottles? Yes ❑ No ❑ Not Presen
Chain of custody present? Yes No ❑
Chain of custody signed when relinquished and received? Yes No ❑
Chain of custody agrees with sample labels? Yes ❑ No
Samples In proper container/bottle? Yes No ❑
Sample containers intact? Yes 0 No ❑
Sufficient sample volume for Indicated test? Yes 0 No ❑
All samples received within holding time? Yes W No ❑
Containerfremp Blank temperature in compliance? Yes R No ❑
Water - VOA vials have zero headspace? No VOA vials submitted W Yes ❑ No ❑
Water - pH acceptable upon receipt? Yes ❑ No W1
Adjusted? Checked b
Any No and/or NA (not applicable) response must be detailed in the comments section be
Client contacted - ATC Date contacted: () Person contacted WA c~ d j
Contacted by: Regarding: SAm t
Comments: 2 lai L rt,c ek- y t
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Corrective Action
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NYC-WTC 000131866
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