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Irtclicape TestiriX Services <br /> Anamctrix laboratories <br /> SAMPLE RECEIVING CHECKLIST <br /> ORKORDER NUMBER 1I q//.2C ;' <br /> CLIENT PROJECT ID <br /> COOLER <br /> Shipping slip (airbill, etc ) present? YES No ;Na//,,�If YES, enter carrier name and airbiIlCustody Seal on the outside of cooler? YEs No <br /> Condition INTACT BROKEN <br /> Temperature of sample (s) within range? ITS 'o NIA <br /> t List temperature of cooler(s) <br /> I <br /> SAMPLES <br /> Chain of custody seal present for each container" YES NO 'IA <br /> Condition INTACT BROKEN I <br /> Samples arrived within holding time? YES No w,a <br /> Samples in proper containers for methods requested" � NO <br /> Condition of containers INTACT ✓ BROKEN <br /> If NO, were samples transferred to proper container" <br /> i <br /> ere VOA containers received with zero headspace" SEs �o <br /> �� i <br /> IA <br /> O, was it noted on the chain of custodv" <br /> Were container labels complete' (ID, date, time preser,air,e etc ) <br /> 'ere samples preserved with the proper presernatn e" }Es No /'N/A i <br /> If NO, was the proper preservatr�a added at time of receipt" <br />�H check of samples required at time of receipt" YES o <br /> If YES, pH checked and recorded by i <br /> i,ufficient amount of sample received for methods requested? SEs, No <br /> f NO, has the client or lab project manager been notified" �J <br />;jeld blanks received with sample batch? # of Sets YES No NIA_ <br /> p blanks received with sample batch? # of Sets SEs No N <br /> IN OF CUSTODY <br /> Fain of custody received with samples? YES No <br /> las it been filled out completely and in ink? YEs No <br /> pie ID's on chain of custody agree vAth container labels? YES No <br /> umber of containers mdicated on chain of custody agree with number received? <br /> /f <br /> No <br /> alysis methods clearly specified? No <br /> brig date and time indicated? (VEs No <br /> r signatures of sampler, couner, sample custodian in appropriate place? with time and date" No <br /> around Ume7 REGULAR RUSH <br /> Any NO response and/or any "BROKEN" that was checked must be detailed in the Corrective Action Fora. <br /> Imple Custodian '1 'L� Date It/l s1 <br /> Project A�znzser Date <br />