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TestAmerica Cooler.Receipt Form/Narrative Lot Number: fla 0S' <br /> North Canton Facility <br /> Client a ?-ao t Project as,` <br /> Cooler Received on ,1 -1 p Opened on I .ea (Signature) <br /> FedEx2'UP5 ❑ DHL ❑ FAS ❑ Stetson ❑ Client Drop Off❑ TestAmerica Courier❑ Other <br /> TestAmerica Cooler# Multiple Coolers ❑ Foam Box. Client Cooler ❑ Other <br /> 1. Were custody seals on the outside of the cooler(s)? Yes ❑ No 0- Intact? Yes ❑ No ❑ NA <br /> If YES, Quantity Quantity Unsalvageabie <br /> Were custody seals on the outside of cooler(s) signed and dated? Yes ❑ No ❑ NA (]� <br /> Were custody seals on the bottle(s)? Yes ❑ No <br /> If YES, are there any exceptions? <br /> 2. Shippers' packing slip attached to the cooler(s)? Yes J;J--No ❑ <br /> 3. Did custody papers accompany the sample(s)? Yes ❑-No ❑ Relinquished by client? Yes P-No ❑ <br /> 4. Were the custody papers signed in the appropriate place? Yes El—No ❑ <br /> 5. Packing material used: Bubble Wrap 2- Foam 0' None ❑ Other <br /> 6. Cooler temperature upon receipt 3-c1 °C See back of form for multiple coolers/temps ❑ <br /> METHOD: IR 40' Other ❑ <br /> COOLANT: Wet Ice a' Blue Ice ❑ Dry Ice ❑ Water ❑ None ❑ <br /> 7. Did all bottles arrive in good condition (Unbroken)? Yes .0-No ❑ <br /> 8. Could all bottle labels be reconciled with the COC? Yes 0" No ❑ <br /> 9. Were sample(s) at the correct pH upon receipt? Yes ❑ No ❑ NA ,0 <br /> 10. Were correct bottle(s) used for the test(s) indicated? Yes [�-No ❑ <br /> 11. Were air bubbles>6 mm in any VOA vials? Yes ❑ No ❑ NA D'- <br /> 12. <br /> '12. Sufficient quantity received to perform indicated analyses? Yes.-0- No ❑ <br /> 13. Was a trip blank present in the cooler(s)? Yes� No ❑ Were VOAs on the COC? Yes ❑ No=0". <br /> Contacted PM Date by via Verbal ❑ Voice Mail ❑ Other❑ <br /> Concerning _. <br /> 14.. CHAIN OF CUSTODY.' . <br /> The following discrepancies occurred: <br /> 15. SAMPLE CONDITION <br /> Sam le(s) were received after the recommended holding time had expired. <br /> Sample(s)) were received in a broken container. <br /> Samples were received with bubble >6 mm in diameter. (Notify PM) <br /> 16.. SAMPLE PRESERVATION <br /> Sample(s) were further preserved in Sample <br /> Receiving to meet recommended pH level(s). Nitric Acrd Lot#051010-HNO3; Sulfuric Acid Lot#051010-H2SO4; Sodium <br /> Hydroxide Lot#100108-NaOH; Hydrochloric Acid Lot#092006-HCl, Sodium Hydroxide and Zinc Acetate Lot#1001 OB- <br /> (CH,9COO)2ZN/Na0H. What time was preservative added to sample(s)? <br /> Client ID gH Date Initials <br /> SOP: NC-SC-0005,Sample Receiving <br /> "QC2MtlR& ]V, gesL4mencalCoolerReceiptTesiAmericaICOOLER_Test4menca_Rev78-063010.doc <br /> 17 of 19 <br />