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0 <br /> McCamabell Analytical, Inc. 1534 Will..Pus Road,Pireburg,CA 94565-1701 <br /> �� Wcb:mvw.mrmmpbelL® E-mxil:mnfe(n]m® *LLwn <br /> (�, <br /> @� "When Ounlity Caun6' Tel hone:977-82-9261 Fox:935452-9269 <br /> Sample Receipt Checklist <br /> Client Name: Safety Kleen Date and Time Received: 7/21088:04:24 PM <br /> project Name: Test Dirt Checklist completed and reviewed by: Ana Venegas <br /> WorkOrder N': 0807078 Matrix Soil Carrier. 1�pS <br /> Chain of Custody(COC)Information <br /> Chain of melody present? Yes R) No❑ <br /> Chain of custody signed when relinquished and received? Yes No❑ <br /> Chain of custody agrees with sample labels? Yes Pb❑ <br /> Sample IDs noted by Client an 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 /> Samplo Receipt Information <br /> Custody seals Intact on shipping container/cooler? Yes 11 No❑ NA ❑ <br /> Shipping container/cooler in good condition? Yes ® No❑ <br /> Samples in proper containers/bottles? Yes R3 No❑ <br /> Sample containers intact? Yes © No❑ <br /> Sufficient sample volume for indicated test? Yes R1 No❑ <br /> Sample Preservation and Hold Time IHT)Information <br /> All samples received within holding bme? Yes © 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 0 No❑ <br /> TTLC Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA <br /> NOTE if the"No"box is checked,see comments below. <br /> _____________________________________________ <br /> --------------------------------------------- <br /> Client contacted: Date contacted: Contacted by: <br /> Comments: <br />