NYC 9/11 Public Portal Document
PSC Analytical Services
Sample Receipt Checklist
Client Name JLC ENVIRONMENTAL CON Date and Time Receive 3/6/2003 1:00:00 PM
Work Order Numbe R03030259 Received by SUB
Checklist completed b Reviewed by 3 •/t "O' 3
Signature Date Initials Date
Matrix Carrier name FedEx
Shipping container/cooler in good condition? Yes No ❑ Not Presen ❑
Custody seals intact on shippping container/cooler? Yes ❑ No ❑ Not Presen I 1
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 LI
Sample containers intact? Yes No ❑
Sufficient sample volume for indicated test? Yes No ❑
0 All samples received within holding time?
Container/Temp Blank temperature in compliance?
Yes (]
Yes 0
No ❑
No ❑
Water - VOA vials have zero headspace? No VOA vials submitted Yes ❑ No ❑
Water - pH acceptable upon receipt? Yes ❑ No Se
Adjusted? Checked b
Any No and/or NA (not applicable) response must be detailed in the comments section b
Client contacted Date contacted: Person contacted
Contacted by: Regarding
Comments:
Corrective Action
•
NYC-WTC 000132140
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