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�an 16 02 01 : 90P APCL <br /> 9095901496 P. 5 <br /> A„pR ed P.& Ch Laboratory <br /> 13760 Maigrioha Ave. China CA 91710 <br /> Tel (909) 590-1$Z8 » (909 0-1 Sample Receiving Checklist <br /> APCL ServicelD• Client Name/Project- 171 <br />' 1 Sample Arrival <br /> Date/Ttme Received t rs z 6 f Y02 Date/Time OpenedI rf L ZdEmx <br /> e) <br /> Custody Transfer C Client C3Golden State ❑ UPS ❑U Mall ❑APCL Empl <br /> 2 Cliain-of-Custody (CoC) <br /> 'With Samples? ❑ Faxed? ❑ Client has Copy? --Q'S geed, dated? By r4l"-51"3 <br />' -�TProject ID? B<n-alyses Clear? ❑ Hold Samples? #on Hold # Received <br /> -ET'C-oC/Docs Zip-Locked under lid? ❑ Compos # _ --CT�ESamples OK? <br />' ❑ Discrepancies? ❑Client notified? ❑ Response (attach docs) <br /> 3 Shipping Container/Cooler <br /> "D-C"oler Used? # of � Cooled by - ce ❑ Blue Ice ❑Dry Ice ❑None <br />' Temp *C ��-- <br /> (Cooler temperature measured from temp blank if present, otherwise measured from the cooler) <br /> Cooler Custody Seal? ❑Absent tact ❑Tampered? <br />' 4 Sample Preservation <br /> ❑ pH <2 ❑pH >12 <br /> If Not, pH Preserved by ❑Client ❑APCL ❑Third Party <br /> 5 Holding-time Requirements <br />' ❑ pH 24hr ❑ BACT 6/24hr ❑CrVr 24hr ❑ NO3 48hr ❑ BOD 48hr <br /> ❑ 02 ASAP ❑Turbidity 48hr ❑ DO ASAP ❑ Fe(II) ASAP <br /> ❑ HT Expired? ❑ Client notified? <br /> 6 Sample Container Condition <br /> tact? ❑Broken? ❑Documented? Number <br /> Type Cl plastic ass ❑ Tube brass/SS ❑Tedlar Bag <br /> -L3.quantity OK? ❑Leaking7 ❑Anomaly? <br /> �aps tight? ❑Air Bubbles? ❑AA aly? <br /> Labels Unique ID7 te/Time --L Preserved? <br /> 7 Turn Around Time <br />' ❑ RUSH TAT Q-Sf�7-10 days) ❑ Not Marked <br /> 8. Sample Matrix <br /> ❑ Drinking HzDOIOther Liq ❑Soil ❑Wipe ❑ Polymer ❑Air ❑Other <br />' ❑ Ground H2O ❑Sludge ❑ Filter ❑ Ori/Petro ❑ Paint ❑W Water ❑ Extract ❑ Unknown <br /> 9 Pre-Login Clleck List Completed & OK? <br /> LL OK7 (If not, attach docs) ❑ Client Contact? (Name )Date/Time <br /> Received/Checked by r7 Date 15 Jan 2002 Time 6 39a m <br />' HT Samples must be analyzed for results to reflect total concentrations Results generated outside required of holding times arc considered mmimal <br /> values and may be used to define waste as hazardous but not as non-hazardous <br /> DaegmentFte [peat tam4iee[aeggacl teR <br />