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CHROMALABi INC. <br /> FSnvironrnentW Service(S DB) <br /> Sample Receipt Checklist <br /> r r,� <br /> J. "lient Name : ate/Time Received: 07/16/97 � �1J <br /> eterence/Submis : 34669 9707210 Received by: <br /> € ,7 7 I Reviewed b : 7 J <br /> -hecklist completed by: Y <br /> rX <br /> Signature Date Initiats Date <br /> IL Carrier name : Client _ `/L <br /> Matrix: So - <br /> Not <br /> hipping container/cooler in good condition? Yes No Present <br /> Not <br /> Custody seals intact on shipping container/cooler? Yes No Present <br /> Not <br /> F-ustody seals intact on sample bottles? Yes No Present V <br /> rfihain of custody present? I Yes No <br /> ?pain of custody signed when relinquished and received? I Yes f/ No <br /> r-Chain of custody agrees with sample labels? Yes y No <br /> i �amples in proper container/bottle? i Yes No <br /> , <br /> _Sample containers intact? Yes � No <br /> 1 .'efficient sample volume for indicated test? Yes ✓ No <br /> All samples received within holding time? Yes No <br /> 'ontainer/Temp Blank temperature in compliance? Temp: 'C Yes No <br /> i <br /> Water - VOA vials have zero headspace? No VOA vials submitted Yes No <br /> aX <br /> - pH acceptable upon receipt? Adjus ed? ( Checked by <br /> chemist for VOAs <br /> Any No and/or NA (not applicable) response must be de ailed in t comments section below. <br /> .:tient contacted: Date contacted: I Person contacted: <br /> k.,ontacted by: Regarding: <br /> i <br /> I <br /> omments: <br /> i <br /> F <br /> F <br /> Corrective Action: <br />