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Inchcape Testing; Set-vices <br /> - I.rrvrr�rnnn•nl.rl Labnr.rtnrn•y <br /> SAMPLE RECEIVING CHECKLIST <br /> Workorder Number: i LC WQ 7 Client Protect ID: �13 I V <br /> Cooler <br /> Shipping documentation presents NO N/A <br /> If YES, enter Carrier and Aubill# <br /> Custody Seal on the outside of cooler? YES NO <br /> Condition Intact Broken <br /> Temperature of sample(s)within ranges S NO N/A <br /> List temperatures of cooler(s) 3 <br /> Note If all samples taken within previous 4 hr,crrcle N/A and place in <br /> le storage area as soon as possible <br /> Samples <br /> Cham of custody seal present for each container? YES NO QM, <br /> Condition Intact Broken <br /> Samples arrived within holden timet SM NO N/A <br /> Samples in proper contamers for methods requested NO <br /> Condition of containers Intact__j,:---Broken. <br /> If NO,were samples transferred to pro2er contame s ? <br />. Were VOA containers received with zero headspace? E NO NIA <br /> If NO, was it noted on the chain of custody? <br /> Were container labels complete? , date, time, resery Uve NO N/A <br /> Were samples properly preserved? Q5 NO N/A <br /> If NO, was the preservatrve added at time of receipt? <br /> pH check of samples required at time of receipt? YES Lyll� <br /> If YES, pH checked and recorded b <br /> Sufficient amount of sample received for methods requested? NO <br /> If NO, has the client or PM been notified? <br /> Field blanks received with sample batch? YES NO P <br /> Tn blanks received with sample batch? NO N/A <br /> Chain of Custody <br /> Chain of custody form received with samples? NO <br /> Has it been filled out coT21etely and in ink? NO <br /> Sample IDs on chain of custody form agree with labels NO <br /> Number of containers on chain W <br /> re with number received? NO <br /> Analysis methods specified? VM NO <br /> Sampling date and time mdicated? VLPP NO <br /> Proper signatures of sampler, couner and custodian in NO <br /> a ro nates aces?With time and date? <br /> . Turnaround time? Standard ✓ Rush <br /> Any NO responses and/or any BROKEN that was checked must be detailed in a Qrrecuve Action Form. <br /> / <br /> Sample Custodian TP Date ; q Project Manager `- Date <br /> f Tbnmvwv=doc <br />