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' Inchcape Testing Service, <br /> Environmental! Laboratories <br /> SAMPLE RECEIVING CHECKLIST <br /> Warkorder Client Quote <br />' <br /> Number- t�2 Project ID. 2etcA 0C Number- tc;lC<-1�' <br /> Cooler <br /> [5h'ppmg <br /> documentation present? YES NO <br />' If YES, enter Carrier and Arrbrll # <br /> ustody Seal on the outside of cooler'? YES NO /A <br /> Condition Intact ❑ Broken L <br />' emperature of sample(s)within range? NO NIA <br /> List temperatures of cooler(s) [,Z=��3•L�,� <br /> Note If all samples taken unthm pre«ous 4 hr,c rcle'�I/A and phase rn sample storage area as <br /> I soon as ssible <br /> Sam les <br /> Chain of custody seal present for each contarner9 YES NO N <br /> LIA <br />' Condition Intact F-- BrokenE: <br /> Samples arrived within holdinsi trme9 , NO NIA <br /> Samples in proper containers for methods requested? QE!) NO <br />' Condition of containers Intact i?— Broken= <br /> If NO were samples transferred to proper contamer(s)? Yes C No ❑ <br />' Were VOA containers received with zero headspace" NO N/A <br /> If NO, were bubbles < 6 mm? Yes E No G <br /> Were container labels com fete`' (ID, date time, reservam,e) YES N N/A <br /> Were samples properly presen ed? Y NO N/A <br /> If NO was the preservam,a added at time of reser t'? Yes ❑ No ❑ <br /> pH check of samples required at time of receipt" YE • NO <br /> If YES pH checked and recorded by 3 e <br /> Sufficient amount of sample received for methods requested7 NO <br /> If NO, has the client or PM been notified" Yes ❑ No <br /> Field blanks received with sample batch" YES NO <br /> Trip blanks received with sample batch9 YE NO N/A <br /> Chain nf Custod= <br /> Cham of custody form reser.ed with sam les9 NO <br /> Has it been filled out completely and in rnk9 NO <br /> I <br /> Sample IDs on chain of custody form agree wmh labels? S NO <br /> Number of containers on chain agree Nvrth number received" S NO <br /> Analvsis methods specified" NO <br /> Sam ling date and time indicated" NO <br /> Proper signatures of sampler courier and custodian in appropriate spaces" NO <br /> With time and date`' Yes L� No <br /> ITurnaround time9 Standard E;-' Rush ti <br /> . 4n,. NO responses and/or anA BROKEN that was checked must be detailed in a Correctne Action Form <br /> Sample Custodian Date rfJ 1 t b Project Manager Date 101141F4 <br /> 1 10MIS u-a dct <br /> n �if � 3 � <br />