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I } r <br /> McCampbell Analytical, Inc. 1534 Willow PassLoomRead,Pittsburg,CA 9Amamp 01 <br /> lVeh:www.�ncaunpbeil.coue E-mail:mninrltnccumplrcU.cam <br /> "Whin Oaajity Caunls" Tcl hone:877-257-9162 (:ax_935-352-9'269 <br /> Sample Receipt Checklist <br /> Client Name: Safety Kleen Date and Time Received. 712108 8:04:24 PM <br /> Project Name: Test Dirt Checklist completed and reviewed by: Ana Venegas <br /> WorkOrder N': 0807078 Matrix Soil Carrier. UPS <br /> Chain of Custody(COC)Information <br /> Chain of custody present? Yes ® No <br /> Chain of custody signed when relinquished and received? Yes 0 No❑ <br /> Chain of custody agrees with sample labels? Yes 0 No❑ <br /> Sample Us noted by Client on 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 /> Urania Receipt Information <br /> Custody seals Intact on shipping container/cooler? Yes © No❑ NA ❑ <br /> Shipping container/cooler in good condition? Yes ® No❑ <br /> Samples in proper containerstbottles? Yes ® No❑ <br /> Sample containers intact? Yes ® No❑ <br /> Sufficient sample volume for indicated test? Yes 0 No❑ <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding lime? 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 R <br /> Sample labels checked for correct preservation? Yes © No❑ <br /> TTLC Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA 21 <br /> NOTE.,lfthe"No*box is checked,see comments below. <br /> --------------------------------------------- <br /> --------------------------------------------- <br /> Client contacted: Date contacted: Contacted by: <br /> Comments: <br />