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• <br /> McCampbell Analytical, Inc. 1574 Willow Pass Road,Pittsb.rc,CA 94565-1701 <br /> Web:www.mccampbellxo n E-mail:min@m=mpbell.com <br /> "When Ooaliw Covets" Telephone:877-252-9262 Fax:925-252-9269 <br /> Sample Receipt Checklist <br /> Client Name: Safety Kleen Date and Time Received: 08/15/0812:59:48 PM <br /> Project Name: Test Dirt Checklist completed and reviewed by: Maria Venegas <br /> WorkOrder N°: 0808446 Matrix Sail Carder: I�4P <br /> Chain of Custody(COC)Information <br /> Chain of custody present? Yes No❑ <br /> Chain of custody signed when relinquished and received? Yes R1 No Cl <br /> Chain of custody agrees with sample labels? Yes 21 % ❑ <br /> Sample IDs noted by Client on COC? Yes © No ❑ <br /> Date and Time of collection noted by Client on COC? Yes 21 No ❑ <br /> Samplers name noted on COC? Yes R1 No ❑ <br /> Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes ❑ No❑ NA <br /> Shipping container/cooler in good condition? Yes 21 No Cl <br /> Samples in proper containers/bottles? Yes R1 No ❑ <br /> Sample containers intact? Yes ✓❑ No ❑ <br /> Sufficient sample volume for indicated test? Yes J❑ No ❑ <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes R1 No ❑ <br /> Containerfiemp Blank temperature Cooler Temp: 27.4°C NA ❑ <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ No VOA vials submitted <br /> Sample labels checked for correct preservation? Yes 21 No ❑ <br /> TTLC Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No Cl NA ❑1 <br /> Samples Received on Ice? Yes Cl No RI <br /> 'NOTE:If the"No'box is checked, see comments below. <br /> _____________________________________________ <br /> _____________________________________________ <br /> Client contacted: Date contacted: Contacted by: <br /> Comments: <br />