On February 14, 2005, the National Institute for Occupational Safety and Health (NIOSH) received a management request for a health hazard evaluation (HHE) at the offices of Scotia Prince Cruises (SPC) in the International Marine Terminal (IMT) in Portland, Maine. Employees of Scotia Prince Cruises were concerned their respiratory and neurologic symptoms might be related to mold exposure in the IMT building. An indoor environmental quality (IEQ) evaluation by a SPC consultant during the summer of 2004 revealed extensive fungal contamination of the SPC portion of the IMT, and employees were relocated in August 2004 to temporary offices. On February 16, 2005, the U.S. Customs and Border Protection (CBP) agency, which is also housed in the IMT building, submitted a separate HHE request based on their concern about exposure to mold and water intrusion. On March 9-11, 2005, NIOSH investigators made an initial site visit of the IMT. This visit included the collection of air, dust, and bulk samples for fungal analyses, and environmental measurements of humidity, temperature, and carbon dioxide. Information concerning the ventilation systems was collected. Confidential interviews were conducted with the SPC and CBP employees. On March 29-30, 2005, NIOSH returned to the IMT to conduct further environmental testing and to complete the confidential interviews of the CBP employees. Blood was collected from the CBP employees for measurement of Stachylysin, a possible marker of exposure to Stachybotrys chartarum. In addition, NIOSH performed an environmental assessment of the U.S. Customs House, another CBP site in Portland with no known history of fungal (mold) contamination in order to compare findings between employees exposed to mold and those not exposed to mold. Confidential interviews and blood collection for Stachylysin were performed with the employees of the U.S. Customs House. Blood from some SPC employees that had been previously collected and stored by physicians in Maine and Maryland between September and November 2004, was obtained by NIOSH for Stachylysin analysis because it was closer in time to when the employees occupied the building in August 2004. The SPC section of the IMT had signs of ongoing water intrusion, pigeon roosting, and visible mold growth in wall cavities. Active fungal growth was noted in areas of the second floor by surface (tape) sampling. The CBP section of the IMT had similar signs of water intrusion and pigeon roosting. Overall, in both portions of the IMT building, low levels of airborne fungi were noted. Most airborne fungi were of the Basidiospore genus, common in water-damaged buildings. Settled dust samples revealed many types of fungi, including Penicillium chrysogenum. Microscopic analysis of tape samples and culturable air samples showed that Stachybotrys chartarum spores and numerous other fungi were present. The walk-through survey of the U.S. Customs House revealed no evidence of water intrusion. Fungal ranking at the U.S. Customs House was found to be similar between indoor and outdoor samples and fungal levels overall were lower indoors than outdoors, providing further evidence that there was no fungal contamination problem in the building. Among the SPC employees, the most commonly reported work-related symptoms were memory problems, irritability, and cough. The CBP-IMT workers reported work-related symptoms of sinus problems, fatigue, concentration problems, and irritability most frequently. SPC employees had statistically significantly greater rates of work-related cough, wheeze, irritated eyes, headaches, concentration and memory problems, irritability, chest tightness, shortness of breath, fever/sweats, body aches, sinus problems, fatigue, sore or dry throat, sneezing, dizziness, confusion, depression, and changes in sleep than Customs House employees. The CBP IMT group had higher rates of work-related cough, shortness of breath, body aches, sinus problems, fatigue, irritated/watery eyes, headaches, nosebleeds, sore or dry throat, sneezing, concentration problems, confusion, memory problems, irritability, and depression than Customs House employees but these differences were not statistically significant. Serum Stachylysin concentrations exhibited poor reproducibility, with same sample mean coefficient of variation of 35.8%. Only one blood sample (from an SPC employee) was considered positive (greater than or equal to 41.4 nanogram per milliliter [ng/ml]) for Stachylysin. Overall, neither the presence of Stachylysin nor its concentrations correlated with our assessment of fungal exposure. NIOSH investigators documented ongoing water incursion and subsequent fungal contamination in the IMT building. Employees in the IMT had symptoms consistent with fungal exposure. Therefore, a health hazard did exist at the IMT building. The serum Stachylysin test showed poor reproducibility when used in the field. Recommendations concerning remediation and the establishment of an IEQ management program are included in this report.