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TEST AMERICA SAMPLI;AAECEIPT LOG <br />CLIENT NAME: Q?RV_ <br />DATE RECD AT LAB: <br />REC. BY (PRINT) k7.V • <br />TIME RECD AT LAB: <br />WORKORDER:2 �^ <br />DATE LOGGED IN: <br />L101 For Regulatory Purposes? <br />5 DRINKING WATER YES 1610 <br />a� WASTE WATER YES ! 1 <br />CIRCLE THE APPROPRIATE RESPONSE <br />LAB <br />SAMPLE # CLIENT ID <br />CONTAINER PRESER <br />DESCRIPTION VATiVE <br />SAMPLE DATE REMARKS: <br />pH MATRIX SAMPLED CONDITION (ETC.) <br />1. Custody Seal(s) Present / <br />Intact / Broken" <br />hQY�R <br />v gl a2 p <br />2. Chain -of -Custody e / Absent* <br />J. Traffic Reports or <br />Packing List: Present / A10 <br />4. Airbill: Alrbill / Sticker <br />Present/ t <br />5. Airbill * <br />8. Sam a Labels: P ese 1 Absent <br />7. Sample IDs+ is 1 Not Listed <br />on Chain-ol-Custody <br />0. Sample Condition: Broken` 1 <br />Leakin " <br />9. Does Information on chain -of -custody, <br />traffic reports and sample labels <br />a res? / No• <br />9 b 0'� <br />V' <br />10. Sample received wlthln ;-4 <br />hold time? 1 No" <br />+. Adequate sample volume <br />received? 1 No" <br />12. rvattves tssdr C o <br />- <br />13. Trip Blank / Temp Blank Received? <br />ckcle which If Yes / <br />14. Read Temp: 3 .2 <br />Corrected Temp: <br />Is corrected temp 4 +1-2°C? / No - <br />(Acceptance range for samples requiring thermal pnu.) <br />"Exception (If any): METALS / DFF ON ICE <br />or Problem COC <br />SPIL ReWsl— 8 <br />;,Replaces ' (07/it?!0� <br />"IF CIRCLED, CONTACT PROJECT MANAGER AND ATTACH REU URD OF KESVLU I IVN, t <br />Page ` of _ �„_ <br />