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F•3RECMA02 M, <br /> �v Revision Date: 01/20/04 Vage: I of <br /> L Stockton Condition Upon Receipt (Attach to COO <br /> Sample Receipt at STK: <br /> LNumber of ice chesisipackages received: <br /> 2. Were samples received in a chilled condition? Temps: —_ <br /> Acceptable is above freezing to 6°C. Also acceptable is received on ice(ROI)for the same day of sampiina ur <br /> received at room temperature(RRT)if sampled within one hour of receipt. Client contact for temperanrce tsilwve <br /> must be documented below. if many packages are received at one time check 1br to <br /> prioritize hither reriew. Please notify Microbiology personnel immediately ol'ham le6 recci%(.ri.- <br /> L 'I. Do the nwnber of bottles received agree with the COC? Yes No N A <br /> 4. Were samples received intact? (i.e. no broken bottles. leaks etc.) )No <br /> ?. Were sample custody seals intact? NA'` Yes Nr <br /> Sign and date. the COC, place in a ziplock and put in the same ice chest as`l ,�- ,1ples <br /> Sample Receipt Review completed by (initials): <br /> Sampie Receipt Sl?: -- -- –" <br /> 1. Were samples received in a chilled condition? Temps: <br /> Acceptable is above freezing to 6°C. If many packages are received at one time check fur tests%H.T. s%r,�,hrs`L;acri's to <br /> priontir.e further review. Please notify Microbiology personnel immediately of bacti samples reeoived <br /> L — <br /> Do the number of bottles received agree with the COC? � No N/A <br /> . Were samples received intact? (i.e. no broken bottles, leaks etc.) �XesNo <br /> 4. Were sample custody Seals intact? N, J Yes No <br /> Sign and date the COC, obtain L1MS sample numbers, select methods/tests and print labels. <br /> Sample Verification, Labeling and Distribution: �� ��} <br /> 1 . Were all requested analyses understood and acceptable? �1 No <br /> 2 Did bottle labels correspond with the client's ID's? �Ye. No <br /> Were all bottles requiring sample preservation properly preserved? Yes No N-A Fill <br /> 4. Weie all analyses within holding times at time of receipt? l'r No <br /> 5 Have rush or project due dates been checked and accepted? A, 1"cs No <br /> Atlach labels to the containers and include a copy of the COC for lab delivet_v <br /> `a.wrlc R(-ceipt. Login and Veritication completed h\' (initials): <br /> Discrepaney Documentation: <br /> L ln\, Items above v.-hicli at(-, or do Ilol meet specifications (i.e. tenips) jnwA L fn. luJol <br /> I PelsonContacte:; Phone Number' <br /> Initiated Liv. Date: <br /> f Prubluu: <br /> Reso)ntion. rhY <br /> ` STK0739802 <br />