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Columbia Analytical Services, Inc. <br /> Sample Acceptance Check Form <br /> Client Shaw Environmental Work order P23Q0698 <br />' ProJeet Don Rodgers <br /> Sample(s) received on 4/11/03 Date opened 4/11/03 by SM <br /> NAW This fol m is used for all samples received by CAS The use of this form for custody seals is strictly meant to Indicate presence/absence and not as an Indication of <br />' comp]lance or nonconformity Thermal preservation and pH will only be evaluated either at the request of the client or as requn ed by the method/SOP <br /> Yes No N/A <br /> 1 Were custody seals on outside of cooler/Box? ❑ © ❑ <br /> Location of seal(s)? Sealing Lids ❑ ❑ <br /> Were signature and date included ❑ ❑ 0 <br /> Were sealsintact9 ❑ ❑ <br /> Were custody seals on outside of sample contamer9 ❑ 0 ❑ <br /> Location of seal(s)? Sealing Lid? ❑ ❑ <br /> Were signature and date included? ❑ ❑ <br /> Were seals intact? ❑ ❑ <br />' 2 Were sample containers marked with client sample ID?_� © ❑ <br /> 3 Did sample containers amve in good.conditions [ I ID ❑ ❑ <br /> 4 Were chain-of-custody papers used and filled out? © ❑ ❑ " <br />' S Did sample container labels and/or tags agree with custody papers9 © ❑ ❑ <br /> 6 Was sample volume received adequate for analysis? © ❑ ❑ <br /> 7 Are samples within specified holdnig times? ❑ ❑ <br /> 8 Was proper temperature(thermal preservation)of cooler at receipt adhered to? ❑ ❑ <br /> Cooler Temperature NA °C <br /> Blank Temperature NA °C <br /> 9 Is pH(acid)preservation necessary, according to method/SOP or Client specified information? ❑ ® ❑ <br /> Is there a client indication that the submitted samples are pH(acid)preservedi ❑ M <br />' Were V A vials checked for presencelabsence of air bubbles? ❑ ❑ <br /> IM <br /> Does the chent/method/SOP require that the analyst check the sample pH and if necessanr alter it? ❑ ❑ ❑x <br /> i <br /> 300698-OOIEMS- <br /> P2300698- NA <br /> 0 <br /> NA <br /> 1 <br /> VaXLny discrepancies (include lab sample ID numbers) <br />' 300699SR XLS Cook, Page 1 of I <br /> 4/11/03 1149 AM <br /> 0057 � <br />