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! Amon Laboratories Sample Receipt Checklist <br /> Client Name ATC Associates, Inc Date&Time Received 10130/2003 <br /> Project Name N&S Irn ation Client Project Number 54 14981 0001 <br /> ' Received By Susan Matrix Water 0 Soil ❑ <br /> Sample Carrier Client ❑ Laboratory ED Fed Ex ❑ UPS ❑ Other ❑ <br /> ' Argon Labs Protect Number D10731 <br /> Shipper Container m good condition? Samples received m proper containers? Yes ❑ Ne ❑ <br /> NIA Yes Q No ❑ Samples received intact? Yes 0 No ❑ <br /> Samples received under refrigeration? Yes ❑ No ❑ Sufficient sample volume for requested tests?Yes ❑ No ❑ <br /> Chain of custody present? Yes ❑ No ❑ Samples received within holding time? Yes ❑ No ❑ <br /> Cham of Custody signed by all parties? Yes No ❑ Do samples contain proper preservative? <br /> ' NIA ❑ Yes No ❑ <br /> Chain of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes ❑ No ❑ (None submitted ❑ ) Yes No ❑ <br /> ANY"No"RESPONSE M <br /> —_---y---�--�-- UST BEDETAILED INTHE COMMENTS SECTION BELOW <br /> —_--_ — <br /> Date Client Contacted Person Conacted <br /> Contacted By Subject <br /> Comments <br /> ' Action Taken <br /> ADDITIONAL TEST(S)REQUEST I OTHER <br /> Contacted By Date <br /> Time <br /> ' Call Received By <br /> Comments <br />