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TestAmericaiCoWer:Recei t Form/Narrative Lot_Number:_ <br /> North Ganton' acil #y <br /> Client S Project By: <br /> Cooler Received bn_ 1 Opened on (Signature) <br /> FedEx UPS ❑ DHL ❑ FAS ❑ tetson ❑ Client Drop Off❑ TestAmerica Courier Other <br /> TestA erica Cooler# Multiple Coolers ❑ F am Box ❑ Client Cooler Other <br /> 1. Were custody seals on th outside of the cooler(s)?Yes � No ❑ Intact? Yes)g No ❑ NA ❑ <br /> If YES, Quantit T Quantity Unsalvageable <br /> Were custody seals on the outside of cooler(s) signed and dated? Yes C6 No ❑ NA ❑ <br /> Were custody seals on the bottle(s)? Yes ❑ No *01 <br /> If YES, are there any exceptions? <br /> 2. Shippers' packing slip attached to the cooler(s)? Yes � No ❑ <br /> 3. Did custody papers accompany the sample(s)? YesPace? <br /> No ❑ Relinquished by client?Yeso No El4. Were the custody papers signed in the appropriate p Yes 0 No ❑ <br /> 5. Packing material used: Bubble Wr Foam None ❑ Other <br /> 6. Cooler temperature upon receipt °C See back of form for multiple coolers/temps ❑ <br /> METHOD: IR Other ❑ <br /> COOLANT: Wet Ice Blue Ice ❑ Dry Ice ❑ Water ❑ None ❑ <br /> 7. Did all bottles arrive in go6d condition (Unbroken)? Yes No ❑ <br /> 8. Could all bottle labels be reconciled with the COC? Yes No ❑ <br /> 9. Were sample(s) at the correct pH upon receipt? Yes No ❑ NA <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? YesNo F-1NA <br /> 12. Sufficient quantity received to perform indicated analyses? Yes No ❑ <br /> 13. Was a trip blank present in the cooler(s)? a No Jg W�er/e VOAs on the CO ? Yes ❑ N <br /> Contacted PM Date by !�V) via Verbal ❑ Voice Mail Other❑ <br /> Concerning <br /> 44. CNAIN OF CUSTODY <br /> The following discrepancies urred: <br /> 1r11 <br /> 35. SAMPLE CONDITION <br /> Sample(s)) were received after the recommended holding time had expired. <br /> Sam les were received in a broken container. <br /> Sample(s)) were received with bubble >6 mm in diameter. (Notify PM <br /> 96. (SAMPLE PRESERVATION <br /> Sample(s) were further preserved in Sample <br /> Receiving to meet recommended pH level(s). Nitric Acid Lot#031909-HNO3; Sulfuric Acid Lot#100108-H2SO4, Sodium <br /> Hydroxide Lot#073007-NaOH; Hydrochloric Acid Lot#092006-HC/, Sodium Hydroxide and Zinc Acetate Lot#050205- <br /> (CH3C00)2ZN/Na0H. What time was preservative added to sample(s)? <br /> Client ID gH Date Initials <br /> SOP.,NC-SC-0005,Sample Receiving <br /> KIORQCIN4�RATIfEL'f -ericalCoolerReceiptTesMmericaM0LER_TeA4merica Rev70040109.doc <br /> Y3ge181oyf 200 <br />