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X040 109Y <br /> Columbia Analytical Services, Inc. <br /> . Phoenyx,AZ <br /> ISample Receipt and reservation Form <br /> Client _ fit '� co� Project Name <br /> ISample(s)Received on A %,J 04 date Oq S-0 time <br /> VOA's54, Glass Bottles Plastic Bottles ❑ Jars❑ Sleeves❑ Tedlar Bags ❑ <br /> IMATRIX SOIL❑ WATER VAPOR❑ <br /> IFust Extraction Holding Time Expiration date time(soils only) <br /> Is first extraction/analysis holding time expiration LESS THAN 24 HOURS(soil)/7 DAYS (water)? Yes❑ No❑ <br /> If YES, chemist notified on date time Chemist's Initials <br /> I1 Rush or standard turn-a-round tune? RUSH ARD <br /> 2 Are the custody seals present? Yes❑ Noz <br /> IIf yes,how many and where? <br /> 3 Are the signature and date correct? Yes)4 NOD <br /> 4 Did all containers arrive in good condition? Yes V NOD <br /> I5 Are all container labels complete(i a preservation,sample ID)? Yes)2 No❑ <br /> 6 Were the correct containers used for the tests indicated? Yes 1° NOD <br /> 7 Have VOA's been checked for the presence of air bubbles? (note problems in comments) Yes, NOD N/AD <br /> 8 Is there sufficient sample volume to perform the requested analysis? Yes/ No❑ <br /> 9 Temperature of sample(s)upon receipt <br /> Explamation of discrepancies <br /> VOA Vial pH Verification <br /> (Tested After Analysis) <br /> YES NO ❑ All Samples pH s 2 <br /> pH Reagent > 9 <br /> 12 NaOH <br /> 2 HNO3 <br /> 2 H,SO4 <br /> 2 HC1 <br /> Comments y JL_. � 4 lJ U l u-1(-a 4�.. -- <br /> I <br /> IForm Completed and Sample(s) Received by(initials) <br /> rlcommonlformstsamprecv doc l <br /> Revised 9/20/2004 10 55 AM <br />