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• <br />Accutest Laboratories Northern California Sample Receiving Check List <br />' <br />Review Chain of Custody Chew of Custody is to be complete end W.Ibie. <br />VAAre these regulatory 0*1V Sfeemplaa9 614'k- <br />til No <br />pT all requested? <br />Yes / (° <br />o Was Client Informed that hold lima h 15 min? Yes/No Continue Yee l No <br />o Wes ad" phosphate filtered Wih in i6 mm? Yes I No Co fir. Yes / No <br />e94e sample Within hell time? <br />&I N. <br />L!Am Semple In daBorroof exceeding hold -time <br />qea:ane Client? EAargi Project?Pao) pnj01.� <br />yea? <br />Yes /(9 <br />e1latl <br />11 Np: 1. Report to Into complete and legible, Including; <br />' <br />p8elhrerebie,v1teme o -Montan; gyhmer ygmeti <br />Is Bill to Into complete and legible, Including; <br />. PON o Co ditcard . Contact nadd... . phone o e m.11 <br />Is Contact andler Protect Menage, Idenlillad, Including; <br />O hone otmall <br />.,Krolect name/number <br />' <br />Almost requlin main.? <br />ptampie lDs / date & time of collection provided? <br />�Yon <br />iD No <br />94S MSW listed and ..Of? <br />✓= Yy No <br />p�nalya.. listed. -us, or client he. authorised a.ubcontm.t <br />C��'N0 <br />./Chaia is Slgped and dated by both client and sample c.mdlen? <br />(51 No <br />' <br />,'AT reeuesied evalleble? 09 No Approved by,E�4 <br />Review Coolers <br />Ams ell CDSImS temPemtums meas.ed at sWC? <br />If cooler Is Outside me sWC; note down the Waacted but. In met coolaran tha left <br />VV <br />' <br />yb. eemples on Ice? <br />�/No <br />Note that ANC does NOT accept evidentiary samplca. (We do not lock refrlgaretoral <br />o'Ihipment Received Melhod FC <br />' <br />.Eualody Basis: present: Yes IlYea; Unbroken: <br />Yes/ No <br />evlo oBo uens ale o .ld <br />Cheln match.. bottle labels? (�ripNo p4emple bate miner? <br />No <br />psi/s there enough Semple volume In proper bottle far requested analyses? <br />�No <br />' <br />.Proper Preserve...? O/N. <br />//Check pH on preserved sample. except tae.,....... end VOMmake note. on led. <br />"-dspece-VOM? <br />Om.lar then amm In diameter <br />List sample 10 and affected container <br />You I`D <br />0 <br />Job#: Cl'jig8 <br />Non -Compliance issues and discrepancies on the COC are forwarded to Project Management <br />Initial: 7w1 <br />\V4munw.amulestwmWepts\ga\.opsbop completelisl 2010Wurrent aclive sop oct�OlOLscODif1 0_formi_samplewntol samplemc ivingchecklist 2009-01-01.doe <br />C:17728: Chain of Custody <br />Page 2 of 2 <br />Ell 19 of 29 <br />w ACCUTEE;-F <br />c1772e <br />