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Revision IIDate.10/09/14 Page.1.of 1 <br /> Inter- ttoly iCondittnotrn UponReceipt(At[ ach, to CDC <br /> SampleReceipt at. Cc CH VI: � <br /> 1. Number of ice chestsipackages received: _Shipping tracking#- <br /> 2. Were samples received in a chilled condition? Temps_ q f I i F <br /> Surface waterSWTR.bact samples.A sample that has a temperature.upomreceipt:of?10-C;whether iced:orm% <br /> should be flagged anl'ess the:time since sample collection has been less than two,hours.. <br /> 3- Do the number of bottles received agree with the COC? Q9) No, N!A <br /> 4_ Were samples received intact? (i.e. no broken bottles,leaks etc:} Qe V NQ <br /> 5'. VOAs checked.for Headspace? Yes. No <br /> 6, Were.sample custody seals intact? Yes No <br /> 7. If required,,was,sample split for pH analysis? Yes; No N/" <br /> S. Were all analyses within holding times at time of.receipt?' (T,00� Nu <br /> 9, Verify sample date, time and. sampler name (-Vtft� No <br /> Sign and date the COC,,place in a ziplockand put in the same ice chest as.t a samples. <br /> Sample Receipt.Review completed by (initials):.h y9k <br /> Sample Receipt of SP: <br /> 1. Were samples received in.a.chilled condition? Temps: <br /> Acceptabre.is above freezing to 6`w,C. If many packages,arexeceived atone time check:forted// T. s/,ushese <br /> 2_ Shipping.tracking.numbers: <br /> S <br /> 3. Do the number.of bottle&received agree.with the COC?' No NrA- <br /> 4. Were samples received intact? (i.e. no broken bottles, leaks etc.) vk� No <br /> 5.. Were sample custody seals intact? Yes Na <br /> Sign and date the COC, obtain LIMS sample;numbers, select methods/tests aiid print[abeIs <br /> Sample.Verification,.Labeling and Distribution: <br /> 1. Were all requested analyses understood and acceptable? No <br /> 2. Did bottle label's correspond with.the client's ID's? s; Na <br /> 3� Were-all bottles requiring sample preservation properly preserved? -Y(=' Na NIA: EGL <br /> IExe ption:.0il&Grease;VOA and C&I eeriffed in labL <br /> 4. VOAs checked forHeadspace? Yes No ISA <br /> 5. Have rush or project due dates been checked and accepted.? Yes: No <br /> 6. Were all analyses within holding times at time of'receipt? �es MO, <br /> Attach labels.to the containers-and.include a copy of the COC"for b delivery. <br /> Sample Receipt,.Login.and Verification.completed by (initials):. <br /> Discrepancy Documentation: <br /> Any items above which are"No"or do not meet specifications(i.e. temps)must:be zesoIved,, <br /> 1. Person,Contacted: Phone.Number: <br /> Initiated By: Date: <br /> Problem:. <br /> Resolution: <br /> 2.. Person.Contacted: Phone,Number. <br /> Initiated.By: - - — - --- - <br /> Problem:: (3012023) <br /> Resolution: luhdorlf & Scalmanini Consulting <br /> (Please use the back of this sheet.for additional.comm( STP256135 <br /> contacts) <br /> cda 11/16/2022 09:47:21 <br /> �lIOQ I <br /> STK�6436C]35��l1�1�1 <br /> ST5 <br />