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ul. i -rat-LnnC Ito :.4-+ H11 L1�74644H11� P. Z9 <br /> FGL l nvirowriental <br /> Revision Datc: 10/20/00 Doc ID: RMFC005.o0 <br /> Page: I of 1 <br /> Stockton - Condition Upon Receipt (Attach to COC) <br /> Sample Receipt at STIC: <br /> 1. Number of ice ohests/packages received: <br /> 2. Were simples received in a chilled condition? Temps:`_ <br /> Acceptabl is above freezing to 6°C. Note as AOT(arrived on ice) if chilling was begur.for samples received on <br /> same clay of sampling, <br /> 3. Do then mber of bottles received agree with the COC? <br /> -es No N/A <br /> 4. Were s� ples received intact? (i.e. no broken bottles, leaks etc.) No <br /> S. Were sample custody seals intact? <br /> Yes No <br /> Sign and date t e COC,place in a ziplock and put in the same ice chest a <br /> Sample Rcceipt Review completed by(initials): {� 1 S <br /> Sample Recei (� <br /> A p at 5P. � <br /> 1- Were samples received in a chilled condition? Temps:_ ✓_/_ / <br /> Acceptable Ls above freezing to 6' y p�cka aC. rfmvn ics are received atone time c,cck for tesroi.T.'s/rttsheslBacti's to <br /> 6 <br /> pfioritize furzh r review. Plcase notify Microbiologypersonncl irnmediatcly of bncti samples reecived. <br /> 2. Do the mixtiber of bottles received agree with the COC? <br /> - Yes No N/A <br /> 3. Were satrap es received intact? (i.e. no broken bottles, leaks etc.) Yes No <br /> 4. Were same a cultody seals intact? <br /> N/A. Yes No <br /> obtain I,IMS samplenumbers, select methods/tests and print labels. <br /> Sample Verificallon, Labeling and Distribution: <br /> L Were all requested artalyses understood and acceptable? <br /> No <br /> 2. Diel bottle labels correspond with the client's ID's? <br /> e No _ <br /> 3. Were.all bot les requiring sample preservation properly preserved'? No <br /> 4. Were all ana yscs within holding times at tinN <br /> tinge of t? N/ FG,t. <br /> P =e o <br /> 5. -Have rush or project due dates been checked and accepted? N/A Yes No <br /> Attach labels to the containers and include a copy of the COC for lab deliv 1 <br /> Sample Receipt, Login and Verification completed by(initials): <br /> Discrepancy Documentation: <br /> Any items above which are "No" or do riot meet spccifications (i.e. temps) must be resolved. <br /> I. Person Contacted: Phone Number: <br /> Initiated By: —__—A - — Datc: ____------ <br /> Problem: --a _—_. --- - — - - <br /> 3012628 <br /> mew <br /> CZcsulution: Keystone Automotive Industries Inc. <br /> �-2 STK233070 <br /> Tamp:_a-aq <br /> AUG-1G�—��A� 13:AA �AgdFddAIA qui 0 'Do �. ,m <br />