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CHRONIALAB, INC. <br /> SA11�tPLE RECEIPT CHECKLIST <br /> • Client Nam Date/Time Receive <br /> ProjectReceived by ate / Time <br /> Reference/Subm # .7-96,v-7 961)q-5f-36 Carrier name <br /> Checkl s pl /C�j Logged in -7h,/43 <br /> by Z f') Initials / Date <br /> Signature / Date Matrix (/ <br /> Shipping container in good condition? NA Yes No <br /> Custody seals present on shipping container' Intact Broken Yes No <br /> Custody seals on sample bottles, Intact Broken Yes No <br /> Chain of custody present <br /> Yes 0- <br /> Chain of custody signed when relinquished and received? No <br /> Yes <br /> Chain of custody agrees with sample labels-> Yes v No <br /> samples in proper container/bottle? Yes, /Z No <br /> Samples intactl> YesJ�No <br /> Sufficient sample volume for indicated test? Yes ✓ No <br /> VOA vials have zero headspace7 NA Yes /No <br /> Trip Blank received? NA Yes No v <br /> All samples received within holdin time-J Yes `' No <br /> Container tempprat ure?_ /C/)- i <br /> pH upon receipt pH adjusted Check performed by NA ✓ <br /> Any NO response must be detailed in the comments section below I€ items are not <br /> applicable, they should be marked NA <br /> Client contacted? Date contacted? <br /> Person contacted> Contacted by" <br /> Regarding? <br /> Comments <br /> Corrective Action <br /> SNIPLRECD CK <br />