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nchcape Misting Services <br />Environmental Laboratories <br />SAMPLE RECEIVING CHECKLIST <br />1 <br />WORKORDER NUMBER' <br />CLIENT PROJECT ID <br />COOLER �76 5 �3v <br />'(Shipping slip (airbill, etc ) presents <br />If YES, enter carver name and airbill # <br />Custody Seal on the outside of cooler9 <br />' Condition INTACT BROKEN <br />Temperature of sample (s) within range) <br />�i List temperature of cooler (s) `i °C_ <br />5A,'WlYLE5 <br />1961 Concourse Drive <br />sUl1c F <br />5 irn lose., CA 95131 <br />rcl IoB-432-8192 <br />I'd-, 108-432-8198 <br />YES NO Ni a <br />YES NO NIA <br />(::!ED NO NIA <br />Cham of custod) seal present for each container' <br />Yt s \o <br />NSA <br />Condition INTACT ✓ BROKEN <br />YEs <br />NO <br />Sample ID's on chain of custody agree with container labels' <br />Samples a,, ed %%ithin holding tunes <br />i Es <br />\o <br />N/A <br />'mSamples in proper containers for methods requested' <br />YEs '.o <br />YEs ' <br />YE <br />Condition of containers INTACT Z BROKEN <br />Ler signatures of sampler, courier, sample custodian in appropriate place) i%ith time and dates <br />urnaround time) REGULAR RUSH <br />YEs r <br />\o <br />samples transferred to proper container' <br />PeNO,x%eTe <br />re VOA containers recened with zero headspace7 <br />N Es <br />�O <br />AIA <br />If NO, %%as it noted on the chain of custod." <br />Were container labels complete' (ID, date time presen atiNe, etc) <br />1 E5 <br />\O <br />Were samples presen ed with the proper presen atn e" <br />YEs <br />X <br />AIA <br />If NO, ,%% as the proper presen ative added at time of receipt9 <br />pH check of samples required at time of receipt <br />N ES <br />So <br />If YES, pH checked and recorded b% <br />Sufficient amount of sample recened for methods requested') <br />) E5 <br />�O <br />If NO, has the client or lab project manager been notified" <br />Field blanks received with sample batch) # of Sets <br />I ES <br />-1,0 <br />AiA <br />Tnp blanks received with sample batch's # of Sets <br />YES <br />NO <br />—CHAIN OF CUSTODY <br />Chani of custody recened wvith samples <br />YEs <br />No <br />Has it been filled out completely and in inky <br />YEs <br />NO <br />Sample ID's on chain of custody agree with container labels' <br />Es <br />NO <br />Number of containers indicated on chain of custod-, agree with number recei%edl <br />Es <br />NO <br />Analvsis methods clearly specified? <br />ampling date and time indicated? <br />YEs ' <br />YE <br />\O <br />1%O <br />Ler signatures of sampler, courier, sample custodian in appropriate place) i%ith time and dates <br />urnaround time) REGULAR RUSH <br />YEs r <br />\o <br />■ An) NO response and/or an) "BROKEN" tliatly as checked must be detailed in the Correctne Action Form <br />Sample Cus,odimi � Datc t '!96 Project Manager 11A I Date 1� <br />