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TestAmerica Canton Sample Receipt Form/Narrative Login# <br /> Canton Facility 1Cooler unpacked by: <br /> Cliente.t•~ p„}nn Site Name <br /> Cooler Received on <br /> 00 Opened ol 6 " <br /> FedEx: I" Grd x UPS FAS Stetson Client Dro Off TeslAmerica Courier Other 1^ <br /> Receipt After-ho s:Drop-off Dal Gime Storage Location <br /> TestAmerica Cooler# Foam Box Client o ler Box Other <br /> Packing material used: Bu a rap Foam P t Bag None Other <br /> COOLANT: et ce Bluelce Dry Ice Water None <br /> 1. Cooler temperature up n r ipt ❑ Sce Multiple Cooler Form <br /> IR GUN#IR-8(CF +OA°C) Observed Cooler Temp. • <br /> _q_*C Corrected Cooler Temp. �' °C <br /> IR GUN#36 (CF +13°C) Observed Cooler Temp. °C Corrected Cooler Temp. °C <br /> No <br /> 2. Were custody seals on the outside of the cooler(s)? If Yes Quantity_ No NA <br /> -Were custody seals on the outside of the coolerNo <br /> s)signed&dated? YY£&s o G <br /> -Were custody seals on the bottle(s)or bottle kits(LLHg/MeHg)? <br /> 3• Shippers'packing slip attached to the cooler(s)? Ye No <br /> 4. Did custody papers accompany the sample(s)? _) <br /> S. Were the custody papers relinquished&signed in the appropriate place? 3F6 No I <br /> 6. Was/were the person(s)who collected the samples clearly identified on the COC? Yes ] f <br /> 7. Did all bottles arrive in good condition(Unbroken)? No _ <br /> _- - -- - - �8: Could all bottle labels be reconciled with the COC? - - -- _ No--- ` <br /> 9. Were correct bottle(s)used for the test(s)indicated? No i <br /> 10. Sufficient quantity received to perform indicated analyses? No <br /> No <br /> 11. Are these work share samples? <br /> If yes,Questions l 1-15 have been checked at the originating laboratory. <br /> 11. Were sample(s)at the correct pH upon receipt? Yes o NA pH Strip Lot#BC692547 <br /> 12. Were VOAs on the COC? Yes o I <br /> 13. Were air bubbles>6 mm in any VOA vials? Yes No NA <br /> 14. Was a VOA trip blank present in the cooler(s)? Trip Blank Lot# Y No <br /> 15. Was a LL Hg or Me Hg trip blank present? via Verbal Voice Mail Other <br /> Contacted PM Date by <br /> Conceming - <br /> Samples processed by: <br /> 16. CHAIN OF CUSTODY&SAMPLE DISCREPANCIES <br /> I <br /> 17. SAMPLE CONDITION <br /> Samples) were received after the recommended holding time had expired. <br /> Sample(s) were received in a broken container. <br /> sample(s). were received with bubble>6 mm in diameter.(Notify PM) <br /> 18. SAMPLE PRESERVATION <br /> Sample(s) were further preserved in the laboratory. <br /> Time preserved: Preservative(s)added/Lot number(s): <br /> Ref,'SOPNC.rC 0003,$ample RectB•ing <br /> L'IQAQCIQA 1ep0rtmenr7QA TARO1SIn°cmnmr CWWAWpk]mrrvcdmoVn Rn4siont{91-NL'-099-1tl1716 Coofer Reeeipr Fwm.d°r dll <br /> Page 25 of 28 11/7/2016 <br />