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LIM.S Lot#� ���2�p PROM CT RE,CEIPT CHECKLIST Cont'd <br /> Fraction t <br /> H <br /> H HCL, S H2SO4, N HNO3, V VOA, SL,Sleeve, E Encore, pS Poly Bottle, CGB Clear Glass Bottle, AGJ Amber Glass.lar, T Teri acore <br /> AGB Amber Glass Bottle, n/f/1 HNO3-Lab filtered, n/f HNO3-Field filtered, znna Zinc Acetate/Sodiwn Hydroxide, Na2s2o3 sodium thiosulf to <br /> t <br /> Condition )Upon Receipt Anomaly Form Anomalies S /A�j L4,166 <br /> Vv- <br /> COOLERS m CUSTODY SEALS(COOLER(S) CONTAINER(S) <br /> 0 Not Received(received COC oily) ❑None ❑None <br /> ❑Leaking 0 Not.Intact <br /> O Other. ❑Not Intact <br /> ©Other O Other <br /> TF <br /> MPERATUR) (SPECS 4 t 2°C) CHAIN OF CUSTODY(COC) <br /> 0 Cooler Temp(s) 13 Not relinquished by Client,No date/time relinquished <br /> c2aemperature Blank(s) 0 Incomplete Information provided <br /> • CONTAINERS 0 Other 0 COC not received—notify PM <br /> 0 Leaking ❑Voa Vials with Bubbles a 6mm LABELS <br /> ❑Broken 0 Not the same ID/info as in COC <br /> 0 Extra 0Incomplete Information <br /> ❑Without Labels 0 Marlungs/Info illegible <br /> 0 Other 0 Torn <br /> SAMPLES 0 Will be noted on COC--Client to send samples with new CDC <br /> ❑Samples NOT RECEIVED but listed on COC 0 Mislabeled as to tests,preservatives,etc <br /> ❑Samples received but NOT LISTED on COC la Holding time expired—list sample ID and test <br /> 0 Logged based on Label Information ❑Improper container used <br /> 0 X.ogged based on info from other samples on COC 0 Not preserver)/Improper preservative used <br /> 0 Logged according to Work Pian 0 Improper pH Lab to preset ve sample and document <br /> 0 Logged on HOLD UNTIL FURTHER NOTICE O Insufficient quantities for analysis ❑Other <br /> Comments <br /> ❑Corrective Action Implemented, <br /> O Client Informed verbally on By- 0 In writing on By <br /> 0 Sample(s)on hold until 0 Sample(s)processed"as <br /> Logged byA3ate: Logged in by other STL❑ PM Review - <br /> aAi <br /> A040210 5 <br />