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0 0 <br /> McCamgbellAnal }jCal, Inc. To81534Willa.Pas.RoaAPObbr&CA94565-1701 <br /> r r kphme:(877)252-9262/Fax:(9u)252-9269 <br /> "When Quality Counts" http://w .mccarn*[Lcom/E-mail:mam(mccmnpbell.c <br /> Sample Receipt Checklist <br /> Client Name: Safety Kleen Date and Time Received: 41612012 11:37:28 AM <br /> Project Name: Booth Filters, Hulz Rubber Checklist completed and reviewed by: Maria Venegas <br /> WorkOrder N": 1204148 Matrix: Solid 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 /> Samplers name noted on COC? Yes No❑ <br /> Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes ❑ No� J NA iJ <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(HT)Information <br /> All samples received within holding time? Yes W1 No❑ <br /> Container/Temp Blank temperature Cooler Temp: NA <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ No VOA vials submitted <br /> Sample labels checked for correct preservation? Yes © No❑ <br /> Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA❑� <br /> Samples Received on Ice? Yes ❑ No <br /> NOTE.If the"No"box is checked, see comments below. <br /> ------------------------------------------ <br /> Comments: <br /> Page 4 of 12 <br />