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/� McCamabell AnalvticaL Inc. 1534 Willow Pass Road,Pittsburg,CA 94565-1701 <br /> 'v'i Web:www.mccampbell.com E-maiP mein rJ nccampbell.wm <br /> "When OualiN Counts' Tele hone:877-252-9262 Fen:925-252-9269 <br /> Sample Receipt Checklist <br /> Client Name: Allied Waste Date and Time Received: 514/20119:28:04 AM <br /> Project Name: Independent Trucking, Shop Checklist completed and reviewed by: Maria Venegas <br /> WorkOrder N°: 1105084 Matrix Ej� Carrier: FedEx <br /> Chain of Custody(COC)Information <br /> Chain of custody present? Yes © No❑ <br /> Chain of custody signed when relinquished and received? Yes © No ❑ <br /> Chain of custody agrees with sample labels? Yes ❑ No ❑ <br /> Sample IDs noted by Client on COC? Yes © No ❑ <br /> Date and Time of collection noted by Client on COC? Yes ❑ No ❑ <br /> Sampler's name noted on COC? Yes ❑ No ❑ <br /> Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes ❑ No ❑ NA 21 <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 tHT)Information <br /> All samples received within holding time? Yes 0 No❑ <br /> Containerriemp Blank temperature Cooler Temp: NA <br /> Water-VOA vials have zero headspace r no bubbles? Yes ❑ No ❑ No VOA vials submitted <br /> Sample labels checked for correct preservation? Yes r❑ No❑ <br /> Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA ❑� <br /> Samples Received on Ice? Yes ❑ No 21 <br /> NOTE:If the "No"box is checked,see Comments below. <br /> --------------------------------------------- <br /> --------------------------------------------- <br /> Client contacted: Date contacted: Contacted by: <br /> Comments: <br /> Page 4 of 4 <br />