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Amon Laboratories ' <br /> �o les Sample Receipt Checklist <br /> Client Name Date&Time Received {J/ ! <br /> Project Name _ o Gent Protect Number <br /> 1 Received By -019Matrix Wate, F�ir S011 ❑ Other <br /> Sample Career Client Laboratory ❑ Fed Ex ❑ UPS ❑ Other ❑ <br /> ' Argon Labs Protect Number —e.q?/ I <br /> Shipper Conta,ner in good condition? Sufficient sample volume for requested tests?Yes No ❑ <br /> ' N!At❑�` Yes ❑ No ❑ Samples received within holding time? Yes No ❑ <br /> Samples recewed under refrigeration? Yes No ❑ Do samples contain proper preservative? <br /> N/A El Yes � Na ❑ <br /> Chain of custody present? Yes No ❑ VOA vials with preservative? <br /> NIA ❑ Yes No ❑ <br /> Chain of Custody signed by all parties? Yes [� No ❑ VOA vials preservative type <br /> HCL Na2S203 ❑ Other <br /> ' Cham of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes Ell No ❑ NIA ❑ Yes [ / No ❑ <br /> Samples received in proper containers? Yes LJ No ❑ Samples received intact? Yes lam' No ❑ <br /> w ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW— <br /> Date Cfient Contacted Person Contacted <br /> Contacted By Subject <br /> Comments <br /> Action Taken <br /> 1 <br /> ' ADDITIONAL TEST(S)REQUEST I OTHER <br /> Contacted By 1�.A'R1AQ Date 7 a�1�' S� Time <br /> ' Cafl Received By -TAnul. <br /> Comments ra=n nz- i=v 4Vt1U <br /> ? 502 <br />