NYC-WTC_000189694

NYC 9/11 Public Portal Document

PSC Analytical Services

Sample Receipt Checklist

Client Name ATC ASSOCIATES Date and Time Receive 2/12/2002 9 45:00 AM

Work Order Numbe R02020388 Received by JAD

Checklist completed b i/yi/t I Reviewed by Signature I Date Initials

Matrix Carrier name Fed^

Shipping container/cooler in good condition’ Yes 0 No □ Not Presen □ Custody seals intact on shippping container/cooler’ Yes □ No □ Not Presen 0 Custody seals intact on sample bottles’ Yes □ No □ Not Presen 0 Cham of custody present’ Yes 0 No □

Cham of custody signed when relinquished and received’ Yes 0 No □ Cham of custody agrees with sample labels’ Yes 0 No □

Samples in proper container/bottle’ Yes 0 No □

Sample containers intact’ Yes 0 No □

Sufficient sample volume for indicated test’ Yes 0 NoD

All samples received within holding time’ Yes 0 NoD

Container/Temp Blank temperature in compliance’ Yes 0 NoD

No VOA vials submitted 0 Yes □ NoD Water - VOA vials have zero headspace’ Water - pH acceptable upon receipt’ Yes 0 NoD

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

CITY_21MC1OO_OO3O87832

NYC-WTC_000189694