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' Jan 16 02 01 : 90p RPCL 9095901498 P. 5 <br /> Applied p & Citi LaboratorX <br /> 13760 Magnolia Ave,Chino CA 91710 <br /> Tel (909) 590-1828 Fax (909 0-11 Q Sample Receiving Checklist <br /> ff <br /> APCL ServiceID: Client Name/Project: /TJCorG�� _ <br /> ' 1 Sample Arrival <br /> Date/Time Received t rs 6 °� Date/Time Opened 1 rs L vJ By (name) <br /> ' Custody Transfer ❑Client ❑Golden State ❑ UPS ❑ U Mall FedEx ❑APCL Empl <br /> 2 Chain-of-Custody (CoC) <br /> ' 'With Samples? ❑ Faxed? ❑ Client has Copy? Q gned, dated? By <br /> -aProject ID7 ED-A-n-alyses Clear? ❑ Hold Samples? ;ion Hold # Received <br /> -ErCoC/Docs Zip-Locked under IId7 ❑ Compos # — '-EF-#Samples OK7 <br /> ❑ Discrepancies? ❑Client notified? ❑Response (attach docs) <br /> 3. Slupping Container/Cooler <br /> ,-Q-600ler Used? # of Cooled by $Ice ❑ Blue Ice ❑Dry Ice ❑None <br /> Temp OC �� ;t— <br /> (Cooler temperature measured from temp blank if present, otherwise measured from the cooler) <br /> ' Cooler Custody Sea17 ❑Absent . 'Tnn_tact ❑Tampered? <br /> 4. Sample Preservation _ <br /> ❑ pH C2 ❑pli >12 <br /> If Not, pH Preserved by ❑Client ❑APCL ❑Third Party <br /> 5 Holding-time Requirements <br /> ' ❑pH 24hr ❑BACT 6/24hr ❑CrVr 24hr ❑ NO 48hr ❑BOD 48hr <br /> ❑ Cl2 ASAP ❑Turbidity 48hr ❑ DO ASAP ❑ Fe(11)ASAP <br /> ❑ HT Expired? ❑Client notified? <br /> 6 Sample Container Condition <br /> tact? ❑ Broken? ❑ Documented7 Number <br /> ' Type ❑plastic ass ❑ Tube brass/SS ❑Tedlar Bag <br /> 'CkQuantity OK? ❑Leaking? ❑Anomaly? <br /> Rnique <br /> aps tight? ❑Air Bubbles? ❑Amaly? <br /> Labels ID7te/Time preserved? <br /> 7 Turn Around Time <br /> ❑ RUSH TAT -[3-ST6(7-10 days) ❑ Not Marked <br /> 8 Sarnple Matrix <br /> ❑ Drinking H2O Other Liq ❑Soil ❑Wipe ❑ Polymer ❑Air ❑ Other <br /> ❑ Ground H2O ❑Sludge ❑ Filter ❑Oil/Petro ❑ Paint ❑W Water ❑ Extract Ti Unknown <br /> 9 Pre-Login Check List Completed & OK? <br /> ' 'MI LL OK? (if not, attach docs) ❑Client Contact? (Name )Date/Time <br /> Received/Checked by Date 15 Jan 2002 Time 8 39a m <br /> -HT sampics must be analyzed for results to reflect total concentrations Results enerated outsides u <br /> ' S req tred or holding times are considered minimal <br /> values and may be used to define waste as hazardous but not as non-haaardov1s <br /> Dacgnn wtiPile laeai .:l.Ie.Im9e1 Lcy <br />