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• • RECEIVED <br /> FEB 2 6 2014 <br /> ENVIRONMENTAL <br /> ASSOCIATED LABORATORIES HEALTH DEPARTMENT <br /> 806 North Batavia—Orange, California 92868— 714-771-6900 FAX 714-538-1209 <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Section 1 I j <br /> Client: ( V Project: <br /> Date Received: — - p� Sampler's Name: es No <br /> Sample temperature: f3 <br /> Sample(s)received in cooler: Yes N (Skip Section 2) <br /> Shipping Information: <br /> Section 2 <br /> Was the cooler packed with: _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 Microbiolobry sa nple�10 Deg, C or arrival on ice ) <br /> Section 3 YES I NO N/A <br /> Was a COC received? <br /> Is it properly com leted? IDs,sampling date and time, signature,test <br /> Were custody seals resent? t/ <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 correct preservatives? <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: (.Q. I <br /> • <br />