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r.• CHROMALAB, INC. •.� <br /> SAMPLE RECEIPT CHECKLIST �j �Q <br /> ell 3G1C, <br /> Client Name / � Date/Time Received <br /> E <br /> Date / Time <br /> Project ci— 7721V / Received by,`�L <br /> Reference/Subm # , / © LP Carrier nameLil <br /> Check m 1 �f /q Logged i�} spy i� ! <br /> by: ( [ ! � Initials / Date <br /> Signature / Date Matrix <br /> Shipping container in good condition? NA Yes No <br /> Custody seals present on shipping container? Intact Broken Yes No <br /> Custody seals on sample bottles? Intact Broken Yes // No <br /> Chain of custody present? Yes ✓ No <br /> Chain of custody signed when relinquished and received? Yes No <br /> Chain of custody agrees with sample labels? Yes—Z No <br /> Samples in proper container/bottle? Yes—�.Z No <br /> Samples intact? Yes No <br /> Sufficient sample volume for indicated test? Yes '✓ No <br /> VOA vials have zero headspace? NA Yes—tL No <br /> Trip Blank received? NA Yes No <br /> All samples received wttaiin holding time? Yes No <br /> Container tempt,rat:ure?__ <br /> pH upon receipt pH adjusted Check performed by: NA_Z <br /> Any NO response must be detailed in the comments section below. If items are not <br /> applicable, they should be marked NA. <br /> Client contacted? Date contacted? <br /> Person contacted? Contacted by? <br /> Regarding? <br /> Comments <br /> Corrective Action: <br /> SWURD.CK <br />