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' Inchcape Testing Servict <br /> Environmental Laboratories <br /> SAMPLE RECEtVING CHECKLIST <br /> Workorder Client Quote <br />' Number ep i L4 Project 1D: Z�� t)C Number- <br /> Cooler <br /> Shipping documentation present? YES NO , <br />' If YES, enter Carrier and Airbill# <br /> Custody Seal on the outside of cooler? YES NO <br /> Condition Intact❑ Broken D <br /> Temperature of sample(s)within range? NO N/A <br /> List temperatures of cooler(s) `��z�c 1-C 2 3' <br /> Note If all samples taken widun previous 4 hr,circle'�1/A'ap <br /> nd Faoe m sample storage area as <br />' soon as possible <br /> Sam les <br /> Chani of custody seal present for each container? YES NO N <br /> ICondition Intact ` Broken u <br /> Sam les arrived within holding tune' , NO N/A <br /> Samples in proper containers for methods requested? NO <br /> Condition of containers Intact Fer' Broken <br /> If NO, were samples transferred to proper container(s)7 Yes❑ No ❑ <br /> . Were VOA containers received with zero headspace' NO NIA <br /> If NO, were bubbles < b mm" Yes D No E] <br /> Were container labels coin lete9 (ID date time, reservative) YES N N/A <br /> Were samples properly presen ed" YE3^' NO N/A <br /> If NO, was the preservati,,e added at time of receipt" Yes--' No <br /> pH check of samples required at time of receipt9 YE NO <br /> If YES pH checked and recorded by `S f <br /> Sufficient amount of sample received for methods requested? • NO <br /> r <br /> f NO, has the client or PM been notified9 Yes,.— No <br /> ld blanks received with sam le batch' YES NO blanks received with sam le batch? YE NO N/A <br /> Chain o Custodain of custodv form reser ed with sam less =. NO <br /> Has it been filled out completely and in ink? NO <br /> Sample IDs on chain of custodv form agree with labels" S NO <br /> Number of containers on chain agree with number received`' S • NO <br /> Anal,sis methods specified" NO <br /> 1 Sam lins7 date and time indicated' NO <br /> 1 Proper signatures of sampler, couner and custodian in appropriate spaces" NO <br /> With time and date" Yes F,,-- No <br /> ITurnaround time9 Standard :;� Rush = <br /> Am NO responses and/or ani BROKEN that was checked must be detailed in a Correctne Action Form <br /> Sample Custodian Date t I A(,,:, Project Manager Date l0 6 <br /> I kxmsn,aui dc, <br /> I3 <br />