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• i RECEIVED <br /> LA\ FEB 2 6 2014 <br /> • ASSOCIATED LABORATORIES EHEAUH NMEN NAL <br /> 806 North Batavia—Orange, California 92868— 714-771-6900 FAX 714-538-1209 <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Section 1 <br /> Client: Project: <br /> Date Received: I I - SLI Sampler's Name: es No <br /> Sample temperature: <br /> Sample(s)received in cooler: No (Skip Section 2) <br /> Shipping Information: <br /> Section 2 <br /> Was the cooler packed with: 'L, Ice _Ice Packs _Bubble Wrap _Styrofoam <br /> _Paper None Other <br /> Cooler Temperature: <br /> (Acceptance range is 0 to 6 Deg. C. or arrival on ice; For Microbiology sanple 10 Deg. C or arrival on ice J <br /> Section 3 YES NO N/A <br /> Was a COC received? L/ <br /> Is it properly completed? IDs, sampling date and time, signature,test <br /> Were custody seals resent? <br /> If Yes—were they intact? <br /> • Were all samples sealed in plastic bags? / <br /> Did all samples arrive intact? If no, indicate below. <br /> Did all bottle labels agree with COC? (ID,dates and times) <br /> Were correct containers used for the tests required? <br /> Was a sufficient amount of sample sent for tests indicated? <br /> Was there heads ace in VOA vials? <br /> Were the containers labeled with correctpreservatives? <br /> Was total residual chlorine measured(Fish Bioassay samples only)? <br /> *: If the answer is no,please inform Fish Bioassay Dept. immediately. <br /> Section 4 <br /> Explanations/Comments <br /> Section 5 <br /> Was Project Manager notified of discrepancies: Y / N N/A <br /> Project Manager's response: <br /> Completed By: Date: (7 L <br /> • <br />