NYC-WTC_000203031

NYC 9/11 Public Portal Document

PSC Analytical Services

Sample Receipt Checklist

Client Name ATC ASSOCIATES Date and Time Receive 9/17/2002 1:00:00 PM

Work Order Numbe R02090971 Received by ADM

Checklist completed b Reviewed by 0^ Signature Date Initials Date,

Matrix Carrier name Subbed direct to PSC-Brq

Shipping container/cooler in good condition? Yes Isa NoD Not Presen

Custody seals intact on shippping container/cooler? Yes J No Not Presen 3

Custody seals intact on sample bottles? Yes □ No □ Not Presen >3

Chain of custody present? Yes No _i

Chain of custody signed when relinquished and received? Yes EZ No U

Chain of custody agrees with sample labels? Yes O No v*

Samples in proper container/bottle? Yes No L

Sample containers intact? Yes 0 No □ Sufficient sample volume for indicated test? Yes 0 NoD

' 11 sampies received within holding time? Yes 0 NoD Container/Temp Blank temperature in compliance? Yes U No 0 Wafer - VOA vials have zero headspace? No VOA vials submitted 0 Yes □ No D

Water - pH acceptable upon receipt? Yes D 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: C/jC ziz- /Z)7. ,

Corrective Action

CITY_21MC100_004092722

NYC-WTC_000203031