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Amon Laboratories Sample Receipt Checklist <br /> C1-r R M �AlC rAr—r-oc 1.15 IPJC- <br /> Date&TimeRecmves o 1 2 - <br /> t prorct lar)E rvv - Client Protect Numae S'4 L Z-5 oco <br /> Received 6r cz Matrix Wale., Scd ❑ Cthe, -- _ <br /> Sarzoie Carl Client ❑ Laboratory ❑r-+' Fed Ex ❑ UPS ❑ Other ❑ <br /> ' Arno-, Labs P,olect Number G,coca ,oy <br /> Shy cer Coma ner�n good condition? Yes <br /> 9 Sufficient sample volume for requested less? �es ❑ tio _ <br /> N/A Yes D-- No ❑ Samples received within holding time? ss '� Flo <br /> Samoaes re,eived under refrigeration? Yes No ❑ Do samples contain proper preservative? <br /> N/A ❑ 'fes ❑--� N� ❑ <br /> Cra;i cf c, t dy present? Yes ❑ No ❑ VCA vials with preservative? <br /> N/A ❑ Y55 ❑�� tJo ❑ I <br /> �r c'Ci s cdy signed by all parties? Yes ❑' No ❑ VOA vials preservative type <br /> HCL [D--Na2S203 [j Otner <br /> ' Chain 0 Cus ody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes No ❑ NIA ❑ "es ❑—f No �] <br /> SarmD es re,e:ved in proper containers? Yes No ❑ Samples received intact? Yes ❑✓ No L] <br /> ---_—ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELO10 <br /> W ------ <br /> Dare Client Contacted Person Contacted <br /> Con acted Dv Subject _ <br /> CcTrrent� _ <br /> Action Tat En <br /> ' -- ---- --�-- ADDITIONAL TEST(S)REQUEST lOTHER <br /> -----r_------� <br /> ' Contacted By Date Time <br /> Call Received By <br /> ' Comments <br /> v502 <br />