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05/27/04 THC 14!32 FAX 805 52' '172 FGL ENVIRONMENTL Z009 <br /> FGL Environmental <br /> Revision Date: 10/11/02 Doc BX,-"3 C005.002 <br /> Stockton C6ndid6n VpoAReceipt (Attach to COCA <br /> Sample Receipt at STK: <br /> L Number of ice chests/Packagesreceived: 3 <br /> 2. Were samples received in a chilled condition? Temps: ZZ Zz Z <br /> Acceptable is above freezing to 60 C. Also acceptable is received on ice(k6T)for the same day of sac>p ' or <br /> rtceived at room temperature(RRT)if sampled within one hots of receipt, Client contact for temperance n,r <br /> must be documented below. If many packages are received at one time check for testslTLT's/tushes/Bactt•s to <br /> Prtorttrze further review. Please notify"Microbiology personnel immediately of baeti so Ica received.. . <br /> I Do the number of bottles received agree with the COC? <br /> No N/A <br /> 4. Were samples received intact?(i.e. no broken bottles,leaks etc.) No <br /> 5. Were sample custody seals iia'tact? <br /> / 'Yes No <br /> Sign and date the COC,place in a ziplock and put in the same ice chest e s les. <br /> Sample Receipt Review completed by(initials): <br /> Sample Receipt at SP: <br /> 1. Were samples received in a chilled condition? Temps: <br /> Acceptable it above freezing to 6°C. If many packages ax received a[one rink cheek for testdH.T.'s/tv6hesrBactl's to <br /> prioritize further review. Please notify Microbiology personnel irtaaediately ofbscti samples received <br /> 2. Do the number of bottles received agree with the COC? � No N/A <br /> 3. Were samples received intact? (i:e.no broken bottles, leaks etc.) No <br /> 4. Were sample custody seals intact? <br /> Yes No <br /> Sign and date the COC, obtain LITAS sample numbers,select methods/tests and print labels. <br /> Sample Verification,Labeling and Distribution: <br /> 1. Were all requested analyses understood and acceptable? No <br /> 2. Did bottle labels corTespond.with the client's ID's? No <br /> e5 No <br /> 3• Were all bottles requiring sample preservation properly preserved? <5� No NIA FGL <br /> 4. Were all analyses within holding times at time of receipt? No <br /> 5. Have rush or project due dates been checked and accepted? Yes No <br /> Attach labels to the containers and include a cop}+of the COC for lab delivery <br /> Sample Receipt,Login and.Yerification completed by(initials): f <br /> Discrepancy Documentation: <br /> Any items above which aze"No"or dont meet <br /> specifications (i.e. temps)must be resolved. <br /> 1. Person.Contacted: Phone Number: <br /> Initiated By: Date: <br /> Problem: —�— <br /> . . I (3-2343) -----��- <br /> Rasolution Clark Well Inc. <br /> STK0433371 <br /> 58-05/18/2004-09:26:18 <br />