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Inchcape Testing Services <br /> Environmental Laboratories <br /> SAMPLE RECEIVING CHECKLIST <br /> ORKORDER NUMBER 9 �1 f 0 3L CLIENT PROJECT ID <br /> DOLER <br /> upping slip(atrbill,etc )presents No NIa <br /> f YES,enter tamer name and aurbill# ZC-(6 6 <br /> atody Seal on the outside of coolers YEs N NIA <br />.ondition INTACT BROKEN <br /> miperature of sample(s)within range) YES No NIA <br />.,ist temperature of cooler(s) 1;`C 1 <br /> kMPLES <br /> hath of custod. seal present for each container" YES NO <br /> Zondrtion TN`'TACT BROKEN <br /> amples am%ed within holding times YE5 "So NIA <br /> amples in proper containers for methods requested' 2E5 No <br /> Condition of containers INTACT �L BROKEN <br /> If NO,%were samples transferred to proper container" <br /> J OA containers recened with zero headspace? Es 4o AIA <br /> A as it noted on the chars of custod' <br /> Jere container labels complete' (ID,date,tune presen ati,%e,etc ) Yt NO <br /> fere samples presenvd with the proper presen ati.e' ',,o N/A <br /> If NO,w as the pr0peT presen atuve added at time of receipt) <br /> H check of samples required at time of receipt' Es No <br /> If YES,pH checked and recorded b) <br /> ucrent amount of sample recet.ed for methods requested' \0° <br /> ffi <br /> If NO,has the client or lab project manager been notified" <br /> teld blanks received.+,ith sample batchl # of Sets Y£5 NO NIA <br /> rip blanks received with sample batchl # of Sets t YES No NIA <br />.HAIN OF r.USTODY <br />,hath of custody recet.ed with samples') YES NO <br /> las it been filled out completely and in rnk9 YES , No <br /> oarnple ID's on chain of custody agree with container labels9 YES NO <br /> lumber of containers indicated on chain of custod+ agree with number recer.ed? YEs Na <br /> analysis methods clearly s ctfred? � NO <br /> iampiung date and time indicated9 YES) No <br /> Iroper signatures of sampler,courier,sample custodian in appropriate place)vnth time and dates YE NO <br /> C and time') REGULAR RUSH <br /> L1 W- An) NO response and/or an) "BROKEN" that r,as checked must be detailed to the orrecti.a Action Form <br /> Sample Cus,odta►t om Date [ �) Project Manager Date _LkPLC <br /> I <br />