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J <br /> Amon Laboratories Sample Receipt Checklist <br /> Client Name: ATC Associates. Inc. Date&Time Received: 121712004 16:17 <br /> Project Name: Farmer Property Client Project Number: 54.62596.0001 <br /> Received By: D.S. Matrix: Water ❑ Soil ❑ <br /> Sample Carrier: Client ❑ Laboratory ❑ Fed Ex ❑ UPS ❑ Other ❑ <br /> Argon Labs Project Number: El 2161 <br /> Shipper Container in good condition? Samples received in proper containers? Yes No ❑ <br /> NIA Yes [] No ❑ Sampies received intact? Yes ❑ No ❑ <br /> Samples received under refrigeration? Yes 0 No ❑ Sufficient sample volume for requested tests?Yes ❑ No ❑ <br /> Chain of custody present? Yes E�l No ❑ Samples received within holding time? Yes No <br /> Chain of Custody signed by all parties? Yes Q No ❑ Do samples contain proper preservative? <br /> NIA ❑ Yes ❑ No ❑ <br /> Chain of Custody matches afl sample labels? Do VGA vials contain zero headspace? <br /> Yes 0 No ❑ (None submitted ❑) Yes No ❑ <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> Date Client Contacted: Person Contacted: <br /> Contacted By: Subject: <br /> Comments: <br /> Action Taken: <br /> ADDITIONAL TEST(S)REQUEST I OTHER <br /> Contacted By: Date: Time: <br /> Call Received By: <br /> Comments: <br />