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I <br /> Amon Laboratories Sample Receipt Checklist <br /> • Client Name ATC Associates, Inc Date&Time Received <br /> 216!2004 1105 <br /> Protect Name USA Gas#110 Client Protect Number 54 25912 0003 <br /> Received By D S Matrix Water 0 Soil ❑ <br /> Sample Carrier Client ❑ Laboratory Q Fed Ex ❑ UPS ❑ Other ❑ <br /> Argon Labs Protect!Number E02121 <br /> Shipper Container in good condition? Samples received in proper containers? Yes ED No ❑ <br /> NIA Yes [] No ❑ Samples received intact? Yes 0 No ❑ <br /> Samples received under refrigeration? Yes El No ❑ Sufficient sample volume for requested tests?Yes 0 No ❑ <br /> Chain of custody present? Yes ❑ No ❑ Samples received within holding time? Yes ❑ No ❑ <br /> Chain of Custody fined by all parties? Yes 0 No ❑ Do samples contain proper preservative? <br /> NIA ❑ Yes Q No ❑ <br /> Cham of Custody matches all sample labels? Do VOA vials contam zero headspace? <br /> Yes ❑ No ❑ (None submitted ❑) Yes ❑ 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 /> i <br /> Action Taken <br /> ADDITIONAL TEST(5)REQUEST/OTHER <br /> Contacted By Date Time <br /> Call Received By <br /> Comments <br /> • <br /> r <br />