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MCCampbellAnalytical Inc 1534 Willow Pass Road,Pittsburg,CA 94565-1701 <br /> Web:www.mccampbell.com E-mail:main@mccampbell.com <br /> "W hen OualiN Counts" <br /> Telephone:877-252-9262 Fax:925-252-9269 <br /> ' Sample Receipt Checklist <br /> Client Name: PSC Industrial Outsourcing, LP Date and Time Received: 6/24/2009 8:14:12 PM <br /> ' Project Name: Sara Lee-Lincoln St, Stockton, Ca Checklist completed and reviewed by: Ana Venegas <br /> WorkOrder N°: 0906761 Matrix 4 Carrier: Benjamin Yslas(MAI Courier) <br /> ' Chain of Custody(CDC)Information <br /> Chain of custody present? Yes No❑ <br /> ' Chain of custody signed when relinquished and received? Yes No❑ <br /> Chain of custody agrees with sample labels? Yes ® No❑ <br /> Sample IDs noted by Client on COC? Yes 0 No❑ <br /> Date and Time of collection noted by Client on COC? Yes ® No❑ <br /> Sampler's name noted on COC? Yes 0 No❑ <br /> ' Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes ❑ No❑ NA 21 <br /> ' Shipping container/cooler in good condition? Yes © No❑ <br /> Samples in proper containers/bottles? Yes © No❑ <br /> Sample containers intact? Yes ® No❑ <br /> Sufficient sample volume for indicated test? Yes 21 No❑ <br /> ' Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes 2 No❑ <br /> Containerlfemp Blank temperature Cooler Temp: 5.4°C NA ❑ <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ No VOA vials submitted <br /> Sample labels checked for correct preservation? Yes © No❑ <br /> TTLC Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA <br /> Samples Received on Ice? Yes ® No❑ <br /> ' (IceType: WtTICE ) <br /> NOTE..If the"No"box is checked,see comments below. <br /> --------------------------------------------- <br /> --------------------------------------------- <br /> Client contacted: Date contacted: Contacted by: <br /> ' Comments: <br /> 1 <br />