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�an 16 02 01 : 30p <br /> APCL 9095901498 F' 5 <br /> Al2pleI <br /> LP_&S1 Laborato <br /> 13760 Magnolia Ave,Chino CA 91710 <br /> Tel (909) 590-1$28 Fax csD9 D-1 Sample Receiving Checklist <br /> 1JL IMF � <br /> APCL ServicelD: Client Name/Project: (� ""'- <br />' I Sample Arrival <br /> Date/Time Received 141512! °'-� Date/Time Opened1 rs L r'J By (name) t <br /> Custody Transfer C Client ❑Golden State El UPS ED] U Mall Fedi=x E3 APCL Empl <br /> 2 Chain-of-Custody (CoC) <br /> ,-Q'Wlth Samples? ❑ Faxed7 ❑ Client has Copy? 10-519-ned, dated? By . <br /> -❑'Project ID7 ❑calyses Clear? ❑ Hold Samples? '#on Bold # Received <br /> -ErC-oC/Docs Zip-Locked under hd7 ❑ Compos # _ -,ff�kSamples OK? <br />' ❑ Discrepancies? ❑Client notified? ❑ Response (attach docs) <br /> 3 Shipping Container/Cooler <br /> 2'C.oler Used? # of Cooled by -Ea ice ❑ Blue Ice ❑Dry Ice ❑ None <br /> Temp °C <br /> (Cooler temperature measured from temp blank if present, otherwise measured from the cooler) <br /> Cooler Custody Sea17 ❑Absent Matt ❑ Tampered? <br /> 4 Sample Preservation <br /> ❑ pH c7 ❑pH >12 <br /> 10 If Not, pH = Preserved by ❑Client ❑APCL ❑Third Party <br /> 5. Holding-time Requirements <br />' ❑pH 24hr ❑BACT 6/24hr ❑ CrV' 24hr ❑ NO 48hr ❑ BOD 48hr <br /> ❑ C12 ASAP ❑Turbidity 48hr ❑ DO ASAP ❑ Fe(II) ASAP <br /> ❑ HT Expired? ❑Client notified? <br />' 6 Sample Container Condition <br /> tact? ❑ Broken7 ❑Documented? Number <br />' Type ❑plastic ass ❑ Tube brass/SS ❑Tedlar Bag <br /> 113,Quantity OK? ❑Leaking? ❑Anomaly? <br /> Punique <br /> aps tight? ❑Air Bubbles? ❑ A maly7 <br /> Labels ID7 '[fate/Time preserved? <br /> 7 Turn Around Time <br />' ❑ RUSH TAT _�7-10 days) ❑ Not Marked <br /> $ Sample Matrix <br /> El Drinking H2O 0-ther Liq 13 Soil ❑Wipe ❑ Polymer E3 Au ❑ Other <br />' ❑ Ground H2O ❑Sludge ❑ Filter ❑ Oil/Petro ❑ Faint ❑W Water ❑ Extract ❑Unknown <br /> 9 Pre-Login Check List Completed & OK7 <br />' LL OK7 (if not, attach docs) ❑ Client Contact? (Name )Date/Tune <br /> • Received/Checked by Date 15 Jan 2002 Time 8 39a m <br />' <br /> HT Samples must be analyzed for results to reflect total concentrations Results generated outside required of haldmg times are considered minimal <br /> values and may be used to define waste as hazardous but not as non-hazardous <br /> Oae•meniPle (nea!tex4leaiimyrel tete <br />