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CHROMALA.B, INC. <br /> SAMPLE RECEIPT CHECKLIST <br /> Client Nam � S Date Time Receive <br /> n Date / Time <br /> ProjectV—O— -CQg / Received by <br /> Reference/Subm #W-%I/J� l Y Carrier name <br /> Check o le �/� /Q/ Logged ins by <br /> by: / /// L�P is / Date <br /> Signature / Date Matrix <br /> shipping container in good condition? NA Yes No <br /> Custody seals present on shipping container? Intact Broken Yes No <br /> Custody seals on sample bottles? Intact Broken Yes No <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 :7No <br /> Samples in proper container/bottle? Yes ✓ No <br /> Samples intact? Yes o <br /> Sufficient sample volume for indicated test? Yes .5�'No <br /> VOA vials have zero headspace? NA Yes No <br /> Trip Blank received? NA Yes No—Z <br /> All samples received within holding time? Yes No <br /> 0 <br /> Container tempernt:ure?__ ' <br /> pH upon receipt H adjusted '/—Z--Check performed by: NA <br /> Any NO response must be detailed in the comments section below. If items are not <br /> applicable, they should be marked NA. <br /> Client contacted? Date contacted? <br /> Person contacted? Contacted by? <br /> Regarding? 4 , <br /> Comments: <br /> Corrective Action: <br /> Sh1PLRECD.CK <br />