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X24 c�c) f X3 <br /> l Columbia Analytical Services, Inc. <br /> . Phoenix, AZ <br /> Sample Receipt and Preservation Form <br /> Client Far f� S-r— e/7{; ed Project Namef,�/1 GGr <br /> I Sam les Received on al°ll GL/ date / J time <br /> VOA's 2r Glass Bottles El Plastic Bottles ❑ Jars ❑ Sleeves ❑ Tedlar Bags ❑ <br /> MATRIx; SOIL❑ WATER VAPOR 0 <br /> First Extraction Holding,Tune Expiration date time(sons only) <br /> Is first extraction/analysis holding time expiration LESS THAN 24 HOURS(soil)/7 DAYS(water)? Yes 0 Noll <br /> If YES, chemist notified on date time Chemist's Initials <br /> 1 Rush or standard turn-a-round time? RUSH TANDA <br /> 2 Are the custody seals present? Yes/0' No[:] <br /> !f yes,how many and where? / Mtk UN <br /> 3.Are the signature and date correcO Yesz No❑ <br /> 4 Did all containers arrive in good condition? YesZ No❑ <br /> 5 Arc all container labels complete(i e preservation, sample ID)? YesZ No ID <br /> 6 Were the correct containers used for the tests indicated? YesZ No❑ <br /> 7.Have VOA's been checked for the presence c)fair bubbles9 (note problems in comments) Yes/0 'No E) N/ACJ <br /> S Temperature of sample(s)upon receipt d �{ <br /> Explaination of discrepancies <br /> VOA Via Verification <br /> t t`_ (Tested After Analysis) <br /> YES NO 01 Samples pH 2 <br /> IpH Reagent ❑ Following Samples Exhibited pH>2 <br /> 12 NaOH <br /> 2 HNO, <br /> 2 HZSO, <br /> 2 HCl <br /> Comments <br /> I <br /> Foran Completed and Sample(s) Received by(initials) <br /> 1 <br /> r lcommonvormslsamprev doc <br /> Revised 02/03/04 9 19 AM <br />