Chain of Custody Form, Environmental Health Investigations, Mar 2002

NYC 9/11 Public Portal Document EHI, Inc. 973-729-5649 p.2O Fri.day, March 01, 2002 10.34 AM Feb,25 02 01:18p PSC flnalatical Services G109219GS7 P.3

PSC Analytical Services

Sample Receipt Checkfist

Client Name ENVIRONMENTAL HEALTH 1 Date and Time Receive 2121/2002 9:30:00 AM Work Order Numbe R02O20734 Received Oy PRS

Checklist completed b Reviewed by 42- SiOftalure Dale "inSab' Date

Matrix Canter name FedEx

Shipping container/cooier in good condilion? Yes S NoLJ NofPreaen □

Custody seals intact on shippping contalner/cooler? Yes □ NoD Not Presen SZ

Custody seals intact on sample bottles? Yes ZD No uZI Not Presen W

Chain of custody present? Yes B NoCl Chain of custody signed when relinquished and received? Yes NoZZ Chain of custody agrees with sample labels? Yes a/ NoD

Samples in proper container/botlle? Yes 0 NoO

Sample containers Intact? Yes Yl No O

Sufficient sample volume for Indicated test? Yes Y MoO All samples received within holding time? Yas 0 NoO ContainerfTemp Blank temperature tn compliance? Yes SI No '2 No VOA vials submitted E Yes n No O Water - VOA vials have zero headspace? Water - pH acceptable upon receipt? Yes 51 NoD

Adjusted? Checked b

Any No and/or NA (not applicable) response must he detailed in the comments section b

Client contacted Date contacted: Person contacted

Contacted by; Regarding

Comments:

Corrective Action

1

NYC-WTC_000186274