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CRROLMALAs, LNC. <br /> SAN PLE RECEEPT CHECKLIST �, l <br /> Client Name Date/Time Rete:. ea <br /> /�(� Q / Time <br /> Pro]ect1� 1J /! Received by-m (�(�C��� <br /> Reference/Su m K � �La L� Carrier name <br /> Checkls o pLete tD I Lagged in by f''L i Q `'� <br /> by /tf[ 1�eo L initials / Date <br /> Signature Dace Matr�.c � <br /> Shipping container in good conditions NA Yes Na <br /> Custody seals present on shipping container' Intact Broken Yes No <br /> Custo(ay seals on sample bottles? Intact Broken Yes No <br /> Chain of custody present? Yes X.// No <br /> Chain of custody signed when relinquished and receivea, Yes -,/ No <br /> Chain of custody agreeswith sample lapels' Yes -INo_� <br /> _ _ <br /> Samples in proper container/bottle' Yes No <br /> Samples zntactI, Yes c <br /> sufficient sample volume for ineicatea test" Yes No <br /> VOA vials have zero headsoace' NA ti/ es No <br /> Trip Blank rete=ved7 NA Yes No <br /> All samples received within holding t;me7 Yes ✓ No <br /> Container temps-rpt ure7 <br /> pH upon receipt uR aa]ustea Check per=ormea by NA <br /> Anv NO response must be detailed in the comments section below If items are not <br /> applicable, they should be marked NA <br /> Client contactea'� Date contacted) <br /> Person contacted' Contact:ea by' <br /> Recardinc-) <br /> Comments �1 L,� (✓ V) �/t Gj L` f_�� _� t �� <br /> Correc�ive Acton <br /> S`1PLIECD C", <br />