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ASSOCIATED LABORATORIES <br />806 North Batavia — Orange, California 92868 — 714-771-6900 <br />SAMPLE ACCEPTANCE CHECKLIST <br />FAX 714-538-1209 <br />Section 1 <br />Client: DI 2J b0{J Project: <br />Date Received: l Sampler's Name: No <br />Sample(s) received iA coole : es No (Skip Section 2) <br />Shipping Information: <br />Section 2 <br />Was the cooler packed with: Ice Ice Packs %Bubble Wrap _Styrofoam <br />-Paper..,,, None _ Other <br />Cooler or box temperature: <br />(Acceptance range is 2 to 6 Deg. C.) <br />Section 3 YES NO N/A <br />Was a COC received? <br />Is it properly completed? (IDs, sampling date and time, signature, test <br />Were custody seals resent? <br />If Yes — were they intact? <br />Were all samples sealed in plastic bags? <br />Did all samples arrive intact? If no, indicate below. <br />Did all bottle labels agree with COC? (ID, dates and times <br />Were correct containers used for the tests required? <br />Was a sufficient amount of sample sent for tests indicated? <br />Was there heads ace in VOA vials? <br />Were the containers labeled with correct prcaervatives? <br />Was total residual chlorine measured (Fish Bioassay samples only)? <br />*: If the answer is no, please mtorm Pisn bioassay Uept- immculmuly. <br />Section 4 <br />Explanations/Comments <br />Section 5 <br />Was Project Manager notified of <br />anciesA Y / N N/A <br />Completed By: ( f I - � Date: <br />