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Indicape Testier^ er'si <br /> p b S des <br /> Anametrix Laboratories <br /> SAMPLE RECEIVING CHECKLIST <br /> tWORKORDER NUMBER z CLIENT PROJECT ID <br /> COOLER <br /> Shipping slip (airbiil, etc ) present? YES No /A <br /> If YES, enter carrier name and airbill # <br />' Custody Seal on the outside of cooler? YES No /A <br /> Condition INTACT BROKEN <br /> Temperature of sample (s) within range? Esq No NIA <br /> List temperature of cooler(s) ° <br /> SAMPLES <br /> Chain of custody seal present for each container? YES No N/ <br /> Condition INTACT BROKEN <br /> Samples arrived within holding time? YEs No NIA <br /> Samples in proper containers for methods requested? C No <br /> Condition of containers INTACT BROKEN ✓ <br /> If NO, were samples transferred to proper container? <br /> Were VOA containers received with zero headspace? Q No NIA <br /> If NO, was it noted on the chain of custody? <br /> Were container labels complete? (ID, date, time preservative, etc } s No <br />'Were samples preserved with the proper preservative? YEs No N/A <br /> If NO, was the proper preservative added at time of receipt? <br /> pH check of samples required at time of receipt? YES No <br /> If YES, pH checked and recorded by <br /> Sufficient amount of sample received for methods requested? YES No <br /> If NO, has the client or lab project manager been notified? <br /> 'Field blanks received with sample batch? #of Sets <br /> YES No w <br /> Trip blanks received with sample batch? # of Sets YES No /A <br /> CHAIN OF CUSTODY <br /> Chain of custody received with samples? YES No <br /> !Has it been filled out completely and in ink? s No <br /> Sample ID's on chain of custody agree with container labels? OESD No <br /> Number of containers indicated on chain of custody agree with number received? YES No <br /> Analysis methods clearly specified? s No <br /> Sampling date and time indicated? /VFNo <br /> roper signatures of sampler, courier, sample custodian in appropriate place" with time and date? <5D No <br /> Turnaround time? REGULAR ✓ RUSH <br /> Any NO response and/or any "BROKEN" that was checked must be detailed m the Corrective Action Form <br /> Sample Custodian 21azDate 3DI14 Project Manager KZ9 4 <br /> J g Date <br />