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STL Den ver <br />a Receiving Checklist <br />Lot M. 12X Date/Time Received: <br />Company Name & St ling Site: <br />*Cooler #(s): <br />Temperatures (°C): � <br />---i' <br />PM to Complete This Section: Yes No <br />Residual chlorine check requited:❑ ❑ <br />Time Zone: <br />• EDT/BST • CDT/CST • M2T/MST • PDT/PST • OTHER <br />Unpacking & Labeling Check Points: <br />N/A Yes No nitiais <br />❑ ❑ 1. Cooler se intact. (NIA if hand delivered) <br />❑ 2. Chain of stody present. <br />❑ 3. Bottles and/or are leaking, comment if yes. <br />❑ 4. Multiphase samples present? If yes, comment below. <br />❑ ❑ ❑ 19. Subcontract CPC signed and sent with samples to bottle prep?. <br />❑ ❑ 20. Were sample l bels double-checked by a second person? <br />Ci ❑ ❑ 21. Were sample bottles and COC double checked for dissolved/lEtered metals by a second person? <br />❑ ❑ ❑ 22. If applicable, v ere AFCEE Metals placed in the walkin refrigerator? <br />❑ ❑ ❑ 23. Were special instructions in LIMS read and followed? <br />Document any problems and the actions taken to resolve them on a Condition Upon Receipt Anomaly Report (CUR). <br />1QA1Forms\Samp1e ReceivinglSR Checklist 1 3/13/03 Revisi <br />G3D050174 STL - Sacramento (916) 373 - 5600 °i� of 35 <br />PHOTOGRAPH BROKEN BOTTLES <br />❑ <br />❑ <br />5. Proper con er & preservatives used (ref. Attachment D of SOF# DEN -QA -M3) <br />❑ <br />❑ <br />❑ <br />6. pH of all samples checked and meet requirements, note exceptions. <br />O <br />Cl <br />7. Chain of cu�tody includes `received by" and `relinquished" by signatures, <br />dates, and tries. <br />❑ <br />❑ <br />8. Receipt date(s) > 48 hours past the collection date(s)? If yes, notify PARK <br />❑ <br />❑ <br />9. Chain of "ody agrees with bottle count, comment if no. <br />❑ <br />❑ <br />10. Chain of custody agrees with labels, comment if no. <br />❑ <br />❑ <br />❑ <br />11. VOA sampl filled completely, comment if no. <br />❑ <br />❑ <br />❑ <br />12. VOA vials p erved, check label. Preservative ❑HCl 04±20C ❑Sodium Thiosulfate <br />❑ <br />❑ <br />13. Did samples quire preservation with sodium thiosulfatc? <br />❑ <br />❑ <br />❑ <br />14. £f yes to #12, 'd the samples contain residual chlorine? <br />❑, <br />❑ <br />❑ <br />15. Sediment pre ant in dissolved/filtered bottles. <br />❑ <br />❑ <br />16. Are analyses th short holding times requested? <br />❑ <br />❑ <br />17. Was a quick �ur, Around (TAT) requested? <br />Cl <br />❑ <br />❑ <br />18. Is extra samplle volume provided for MS, MSD or matrix duplicates? <br />DOOBLEC.FXiECEMETALSSSAMPLE LABELS & SUBCONTRACT <br />❑ ❑ ❑ 19. Subcontract CPC signed and sent with samples to bottle prep?. <br />❑ ❑ 20. Were sample l bels double-checked by a second person? <br />Ci ❑ ❑ 21. Were sample bottles and COC double checked for dissolved/lEtered metals by a second person? <br />❑ ❑ ❑ 22. If applicable, v ere AFCEE Metals placed in the walkin refrigerator? <br />❑ ❑ ❑ 23. Were special instructions in LIMS read and followed? <br />Document any problems and the actions taken to resolve them on a Condition Upon Receipt Anomaly Report (CUR). <br />1QA1Forms\Samp1e ReceivinglSR Checklist 1 3/13/03 Revisi <br />G3D050174 STL - Sacramento (916) 373 - 5600 °i� of 35 <br />