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Amon Laboratories„Sample Receipt Checklist <br /> Client Name ATC Associates, Inc Date&Time Received 5/19/2004 1645 <br /> Project Name USA Gas#110 Client Project Number 54 25912 0003 <br /> Received By D S Matrix Water 0 Sod ❑ <br /> Sample Carrier Client ❑ Laboratory ❑ Fed Ex ❑ UPS ❑ Other ❑ <br /> Argon Labs Project Number E05291 <br /> Shipper Container in good condition? Samples received in proper containers? Yes ❑ No ❑ <br /> NIA Yes No ❑ Samples received intact? Yes [] No ❑ <br /> Samples received under refrigeration? Yes No ❑ Sufficient sample volume for requested tests?Yes [] No ❑ <br /> Chain of custody present? Yes 0 No ❑ Samples received within holding time? Yes 0 No ❑ <br /> Chain of Custody signed by all parties? Yes No ❑ Do samples contain proper preservative? <br /> NIA ❑ Yes [] No ❑ <br /> Chain of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes (] No ❑ (None submitted ❑) Yes F11 No ❑ <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> • Date Client Contacted Person Conacted <br /> Contacted By Subject <br /> Comments <br /> Action Taken <br /> ADDITIONAL TEST(S)REQUEST I OTHER <br /> Contacted By Date Time <br /> Call Received By <br /> Comments <br /> i <br />