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ACCESSION �: 1 a� INITIALS: 1- <br /> ATI.Sanlhego <br /> SAhIP.LE-.CONDITION:UPON RECEIPT':C IECKLIST <br /> OR RACCESSIONS, COMPLETE #7,.'ITARU-.&9} : <br /> 'f£S <br /> � NO <br /> Does this project require special handling according to N�rSC Levels Cr D, <br /> A.cCEE or CLP protocols? <br /> If yes, complete a)and b) <br /> a) pH sample aliquoted: yes /no /na <br /> b) Either 1) Record Bottle Lot Vs: <br /> Or 2) Attach Sample Kit Request Form(s) i <br /> 2 Number of Coolers Received l <br /> If more than one cooler received attach Multiple Cooler Documentation Form 11i <br /> (MCD) <br /> Indicate "see XCD"on Item 11 below <br /> 3 Are custody seals required for this project ? YES N/A <br /> a) are Custody Seals present on Cooler(s) ? V-S NO <br /> If yes, are seals intact ? S NO <br /> b) are Custody Seals present on the sample ? YTS NO <br /> If yes, are seals intact ? _ �S NO <br /> 4 Is there a Chain-Of-Custgdy (COC) Per cooler ? NO <br /> YDS <br /> if not, if a problem is found indicate Which samples/test were in the <br /> affected cooler on the MCD. <br /> NO <br /> 5 Is the CCC' compl per cooler ? <br /> Relinquished: kye,%/no Requested analysis- (ye, /no <br /> ti the s- nles received? YE5 NO <br /> 5 Is theLCO agreement wit.# Sampno SamplDte ampled: ye /no <br /> Ma : a /no containers: <br /> Y=5 NO <br /> 7 Are the samples preserved cor,ectly? <br /> g Are <br /> there enough sample for all the requested analyses? ` hQ <br /> • Y.S <br /> 9 re all samples within holdi-�g times for the requested analyses? NO <br /> 10 Record cooler temperature. Contact ?M if temperature is not 4"C t 2'C. O -C <br /> Is ice present in cooler? � 71 NO <br /> ll Were all sample containers received intact (ie. not broken, leaking, =-s <br /> 5 ` <br /> etc.)? <br /> 12 ;�-e samples requiring no hea_s?ace, headspace free? N/A `' S NO <br /> Y'�S N6 <br /> 13 Are VOA 1st stickers required? <br /> 14 Are there special comments cn the Chain of Custody which require client N/A <br /> contact? <br /> 15 If yes, was F,TI Project r:anager notified? Ir <br /> NO <br /> I r`Z�ce�vec i2. 3ku.K `t5 ,. V 40 ✓AV,4L-- <br /> Describe "no" items. I t <br /> —T V eq ., 4 L-- <br /> Was client contacted? yes / no <br /> If yes, Date: Name of Person contacted: <br /> Describe actions taken or client instructions: <br /> • <br /> *Or other representative documents, letters, and/or shipping memos <br /> ATIMM902(03/95) <br />