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A INITIALS: <br /> ACCESSION #: _ <br /> <S <br /> �fr� �A1�IPLE CONDTlIDN UPO1V RECEIPT'C�EC,�LIST' t . <br /> �`�:_. q OR R�ACCESSIONS, CQMPLETE #7 TffiZU #9) <br /> j Does this project require special handling according to NFESC Levels C, D, YES <br /> AFCEE or CLP protocols? <br /> If yes, complete a)and b) <br /> a) pH sample aliquoted: yes /no /na <br /> b) Either 1) Record Bottle Lot #'s: <br /> Or 2) Attach Sample Kit Request Form(s) <br /> 2 Number of Coolers Received <br /> If more than one cooler received attach Multiple Cooler Documentation Form <br /> (MCD) <br /> Indicate "see MCD <br /> Item 11 below <br /> 3 Are custody seals required for this project ? YES N/ <br /> a) are Custody Seals present on Cooler(s) ? <br /> YES O <br /> If yes, are seals intact ? YES NO <br /> b) are Custody Seals present on the sample ? YES O <br /> If yes, are seals intact ? <br /> YES NO <br /> 4 Is there a Chain-Of-Custody (CDC)' per cooler NO <br /> if not, if a problem is found indicate which samples/test were in the <br /> affected cooler on the )ICD. <br /> 5 Is the COC' complete per cooler ? NO <br /> Relinquished: ymno Requested analysis: a no <br /> 6 Is the COC' 'n agreement with the s3Lwples received? NO <br /> € Samples: s no Sample ID's: no Date sampled: no <br /> Matrix: s no € containers: a /n0 <br /> `= =� 7 Are the samples preserved correctly? NQ <br /> 8 Is there enough sample for all the requested analyses? NO <br /> 9 Are all sar?les within holding times for the requested analyses? <br /> 10 Record cooler temperature. Contact PH if temperature is not 4"C t 2'C -C <br /> °C <br /> Is ice present in cooler? NO <br /> 11 Were all sample containers received intact fie. not broken, leaking, .NO <br /> etc.)? <br /> 12 Ase samples requiring no headspace, headspace free? NIA NO <br /> 13 Are VOA ist stickers reauired? YES ND <br /> 14 Are there special comments on the Chain of Custody which require client <br /> S <br /> contact? <br /> 15 If yes, was ATI Project Manaqer notified? Yrs NO <br /> Describe "no" items: <br /> Was client contacted? yes / no <br /> If yes, Date: Name of Person contacted: <br /> Describe actions taken or client instructions: <br /> -Or other representative documents, letters, and/or shippir.q memos <br />