NYC 9/11 Public Portal Document
PSC Analytical Services
0 Sample Receipt Checklist
3/6/2003 10:10:00 AM
Client Name JLC ENVIRONMENTAL CON Date and Time Receive
Work Order Numbe R03030158 Received by TMH*
`
Checklist completed b / t~ (6 Reviewed by '- 7- o3
Signature Date Initais Date
Matrix Carrier name FedEx
Shipping container/cooler in good condition? Yes 0 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 J 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 l ] No ❑
Sufficient sample volume for Indicated test? Yes No ❑
It samples received within holding time? Yes No ❑
4w -
ontainer/Temp Blank temperature in compliance? Yes No ❑
Water- VOA vials have zero headspace? No VOA vials submitted Yes ❑ No ❑
Water - pH acceptable upon receipt? Yes ❑ No 0
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 000132161
OCR can misread numbers and units. Confirm readings against the page image before using them.