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Inchcape fisting Services <br />Environmental Laboratories <br />SAMPLE RECEIVING CHECKLIST <br />WORKORDER NUMBER <br />' COOLER <br />Shipping slip (airbill, etc ) present? <br />If YES, enter earner name and airbnll # <br />Custody Seal on the outside of cooler? <br />Condition INTACT BROKEN <br />Temperature of sample (s) ♦vtthin range? <br />List temoerature of cooler (s) s C," <br />SAMPLES <br />1961 Concourse Drive <br />suat, is <br />S &n Jose., CA 95131 <br />rel 408-432-8192 <br />1',ex 408-432-8198 <br />CLIENT PROJECT ID 55ZG ✓' 7b51-/ 36 ) <br />YES NO C NI <br />YES NO ( N/A <br />YEsl Pio N/A <br />LLhain of custoa� seal present for each container' <br />YES <br />\O <br />r!a <br />Candmon r,\ TACT BROKEN <br />NO <br />ber of containers indicated on chain of custod% agree with number recei.ed? <br />tnalvsis <br />YES <br />Samples amN ed .nthin holding time? <br />y <br />NO <br />NIA <br />Samples in proper containers for methods requested' <br />ES <br />No <br />signatures of sampler, courier, sample custodian in appropriate place?..-Ith time and date? <br />Condition of containers INTACT 1~/ BROKEN <br />\o <br />Fr <br />urnaround time? REGULAR RUSH <br />NO, «ere samples transferred to proper container" <br />re VOA containers recce ed .with zero headspace7 <br />0e� <br />I Es <br />\o <br />rAf <br />NO, uas it noted on the chain of custod.' <br />ere container labels complete" (ID, date time preser%au.e, etc) <br />l ES) <br />-'O <br />:ere samples presen ed with the proper presen ate e' <br />I ES <br />N0 <br />N/A <br />If NO, -,,.as the proper presen ative added at time of receipt? <br />Hcheck of samples required at time of receipt' <br />y E5 <br />�o <br />If YES, pH checked and recorded b. <br />Wufficient amount of sample recen ed for methods requested' <br />ES <br />No <br />If NO, has the client or lab project manager been notified' <br />Field blanks reccived with sample batch? # of Sets <br />YES <br />i`o <br />rip blanks received with sample batch? # of Sets <br />1 E5 <br />NO <br />N!A <br />mFRAIN OF CUSTODY <br />haus of custodv recemed voth samples? <br />it been filled out completely and in ink? <br />YES <br />NoHas <br />No <br />ample ID's on chain of custody agree voth container labels? <br />YEs <br />NO <br />ber of containers indicated on chain of custod% agree with number recei.ed? <br />tnalvsis <br />YES <br />NO <br />methods clearly specified? <br />YES <br />10 <br />Bawling date and time indicated? <br />YES <br />too <br />signatures of sampler, courier, sample custodian in appropriate place?..-Ith time and date? <br />E5 2 <br />\o <br />Fr <br />urnaround time? REGULAR RUSH <br />rule iNu response antvor an) 0r%kJ&r-f,1 LAW %%as checked must be detailed in the Correctse Action Form <br />Sample Cus,odiwi �,� Date / <br />1 SfC%� Project Manager Date <br />i <br />