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INITIALS: <br /> ACCESS10N <br /> ATS <br /> Di <br /> SAMPLE CONDITION-UPON. <br /> (FOR RE-A.CCESSIONS, COMPLETE'#7..TI-IRU h9} <br /> 1 Does this project require special handling according to NFESC Levels C, D, <br /> AFCrr 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 3's: YES <br /> Or 2) Attach Sample Kit Request Form(s) <br /> 2 Number of Coolers Received <br /> If more than one cooler received attach Multiple Cooler Documentation Form <br /> (MCD) <br /> Indicate "see MCD"on Item 11 below <br /> Llb) <br /> eals required for this project ? S <br /> stody Seals present on Cooler(s) ? YES <br /> e seals intact ? YES NO <br /> tody Seals present on the sample ? YESe seals intact ? YES NO <br /> 4 Is there a Chain-Df-Custody (COC)' per cooler ? (25 NO <br /> if not, if a problem is found indicate which samples/test were in the <br /> affected cooler on the MCD. <br /> YE3 NO <br /> 5 Is the CDC' complete per cooler ? <br /> Relinquished: a /no Requested analysis: e /no <br /> 6 NO <br /> Is the COC' in agreement with the samples received? <br /> Fg <br /> # Samples: 4y-Pl/no <br /> SampleIDner �/no gate sampled: pee/no <br /> NO <br /> 7 Are the samples preserved correctly? <br /> O <br /> 8 Is there enough sample for all the requested analyses? N <br /> CY—F_V NO <br /> 9 Are all samples within holding times for the requested analyses? <br /> 10 Record cooler temperature. Contact PM if temperature is not 4"C ± 2"C. ��aoC <br /> Is ice present in cooler? <br /> E NO <br /> 11 Were all sample containers received intact (ie. not broken, leaking, <br /> NO <br /> etc.)? <br /> S' NQ <br /> 12 Are samples requiring no headspace, headspace free? N/A <br /> YES N <br /> 13 Are VOA 1st stickers required? <br /> 14 Are there special comments on the Chain of Custody which require client YES f�N/J'�) <br /> contact? <br /> YES NO <br /> 15 If yes, was ATI Project Manager notified? <br /> Describe "no" items: <br /> Was client contacted? yes / no <br /> If yes, Date: Name of Person contacted: <br /> Describe actions taken or client instructions: <br /> r <br /> 'Or other representative documents, letters, and/or shia:)inc memos <br />