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Inchcape Testing Services <br /> Environmental Laboratories <br /> SAMPLE RECEIViNG CHECKLIST• <br /> f note <br /> Workorder Client Q <br /> Numher , , 1 Z Y Pro ect ID %�<<1 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 <br /> Temperature of sample(s) within rangesY'� NO N/A <br /> IList temperatures ofcooler(s) 7- <br /> Note <br /> Note Ifall samples taken%,idun previous 4 hr circle NIA and plane in Sample storage area as <br />' soon as ssible <br /> SaTRIes <br /> Chant of custody seal present for each container" YES NO ' <br /> Condition intact _— Broken.] <br /> Samples arrived within holding times YE NO NIA <br /> Samples m proper containers for methods requested" YEAS` NO <br /> Condmon of contanlers Intact .l Broken <br /> If NO, were samples transferred to proper container(s)" Yes - No <br /> Were VOA containers recen ed with zero headspace" YES NO /AJ <br />' If NO were bubbres < 6 mm`' Yes L No <br /> Were container labels com leteO (ID date, time preser,atv�e) QYES i NO N/A <br /> Were samples properly preserved' YES NO <br />' If NO was the reservati\a added at time of receipt" Yes _ No <br /> pH check of samples required at time of receipt" YES (N <br /> If YES pH checked and recorded by <br /> Sufficient amount of sampie recen ed for methods requested' C YS NC <br /> If NO has the client or P%1 been notified`' Yes No <br />' Field blanks received «ith sample batch" YES NO <br /> -Trip blanks received with sam ie batch? YES NO <br /> Chain of Custody <br />' Chain of custody form recen ed Nyith samples" NO <br /> Has it been filled out cam ietely and in ink? NO <br /> Sample IDs on chain of custody form agree with labels' NO <br />' Number of containers on chain agree with number recen ed'' NO <br /> Analysis methods specified' ` NO I <br />' <br /> Sampling date and time indicated" � NO <br /> Proper signatures of sampler courier and custodian in appropriate spaces" NO <br /> With time and date' Yes No = <br />' Turnaround time' Standard Rush W <br /> • An% NO responses and/or ani BROKEN that was checked must be detailed in a Correctne Action Form <br /> tSample Custodian --if Date c t 1 Prc,ect Manager 55r, Date <br />' I l Omts ne-kvs-T d a <br />