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1534 Willow Pass Road,Pittsburg,CA 94565-1701 <br /> M c C a m p b e I l Analytical, Inc. Toll Free Telephone:(877)252-9262/Fax:(925)252-9269 <br /> rr http://www.mccampbeH.com/E-mail:main@mccampbell.com <br /> rr <br /> i When Quality Counts <br /> Sample Receipt Checklist <br /> Client Name: CLS Labs Date and Time Received 6/26/2017 11:05 <br /> Project Name: 17F1017;Dye Penetrant Rinse Date Logged: 6/26/2017 <br /> Received by: Jena Alfaro <br /> WorkOrder Ns: 1706C37 Matrix: Water Logged by: Kena Ponce <br /> Carrier: Client Drop-In <br /> Chain of Custody(COC)Information 7\ <br /> Chain of custody present? Yes 0 No El <br /> Chain of custody signed when relinquished and received? Yes W No❑ <br /> Chain of custody agrees with sample labels? Yes WNo❑ AUG 0 2 2017 <br /> Sample IDs noted by Client on COC? Yes W No❑ <br /> Date and Time of collection noted by Client on COC? Yes ❑✓ No❑ ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Sampler's name noted on COC? Yes ❑ No❑d <br /> Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes ❑ No❑ NA <br /> Shipping container/cooler in good condition? Yes No❑ <br /> Samples in proper containers/bottles? Yes No❑ <br /> Sample containers intact? Yes No❑ <br /> Sufficient sample volume for indicated test? Yes No❑ <br /> Sample Preservation and Hold Time(HTI Information <br /> All samples received within holding time? Yes ❑d No❑ NA❑ <br /> SamplelTemp Blank temperature Temp: 9.5°C NA❑ <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ NA❑� <br /> Sample labels checked for correct preservation? Yes W No❑ <br /> pH acceptable upon receipt(Metal:<2;522:<4;218.7:>8)? Yes ❑ No❑ NA❑� <br /> Samples Received on Ice? Yes ❑d No❑ <br /> (Ice Type: WET ICE ) <br /> UCMR3 Samples: <br /> Total Chlorine tested and acceptable upon receipt for EPA 522? Yes ❑ No❑ NA <br /> Free Chlorine tested and acceptable upon receipt for EPA 218.7, Yes ❑ No❑ NA❑✓ <br /> 300.1,537,539? <br /> --------------------------------------------- <br /> -————————————————————————————---------------- <br /> Comments: -------- <br /> Comments: <br /> Page 7 of 7 <br />