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cCam bell Analytical, Inc. 1534 Willow Pass Road,Pittsburg, A 94565.1701 <br /> Web:www,mcca�npbell.com E-mail:E-ml:main�mccamphell.com , <br /> "When OnalitvCounts" Telephone:877-252-9262 Fax:925-252-9269 <br /> Sample Receipt Checklist <br /> Client Name: Safety Kleen Date and Time Received: 08115/08 1:06:23 PM <br /> Project Name: Test Dirt Checklist completed and reviewed by: Maria Venegas <br /> WorkOrder N°: 0808447 Matrix mil Carrier: UPS <br /> Chain of Custody(COCl Information <br /> Chain of custody present? Yes © . No❑ <br /> Chain of custody signed when relinquished and received? Yes © No❑ <br /> Chain of custody agrees with sample labels? Yes No❑ <br /> Sample IDs noted by Client on COC? Yes ® No❑ <br /> Date and Time of collection noted by Client on COC? Yes d❑ No❑ <br /> Samplers name noted on COC? Yes ❑ No <br /> Sample Receipt 111formation <br /> Custody seals intact on shipping containerlcooler? Yes Cl No ❑ NA 121 <br /> Shipping containedcooler in good condition? Yes © No ❑ <br /> Samples in proper containers/bottles? Yes 0 No ❑ <br /> Sample containers intact? Yes © No❑ <br /> Sufficient sample volume for indicated test? Yes No❑ <br /> Sample Preservation and Hold Time(HTLinformation <br /> All samples received within holding time? Yes 0 No❑ <br /> Container/Temp Blank temperature Cooler Temp: 27.2°C NA ❑ <br /> Water-VOA vials have zero headspace 1 no bubbles? Yes Cl No❑ No VOA vials submitted 0 <br /> Sample labels checked for correct preservation? Yes Q No❑ <br /> TTLC Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA ❑ <br /> Samples Received on Ice? Yes ❑ No 21 <br /> NOTE:If the"No"box is checked, see comments below. <br /> I <br /> — -------- --------- ---------------------------- <br /> I <br /> Client contacted: Date contacted: Contacted by: <br /> Comments: <br />