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ACCESSION #: 60 1 U-Q-(o INITIALS: L <br /> ATI-JSanDiego { <br /> SAMPLE CONDITION UPON RECEIPT CHEiMIST <br /> (FOR RE-ACCESSIONS, COMPLETE #7 THRU#9) <br /> j Does this pro]ect require special handling according to NFESC Levels C, D, YES NO <br /> AFCEE or CLP protocols' <br /> If yes, complete a)and b) <br /> a) pH sample aliquoted yes /no /na <br /> b) Either 1) Record Bottle Lot S's <br /> Or 2) Attach Sample Kat Request Form(s) <br /> 2 Number of Coolers Received <br /> If more than one cooler received attach Multiple Cooler Documentation Form <br /> (MCD) <br /> Indicate "see MCD"on Item 11 below <br /> 3 Are custody seals required for this pro3ect ? <br /> YES N/A <br /> a) are Custody Seals present on Cooler(s) <br /> YES IIN O <br /> If yes, are seals intact <br /> YES NO Kk <br /> b) are Custody Seals present on the sample ? <br /> YES NO <br /> If yes, are seals intact ' <br /> YES NO <br /> 4 Is there a Chain-Of-Custody (COC) per cooler ' / S NO <br /> if not, if a problem is found indicate which samples/test were an the <br /> affected cooler on the MCD <br /> 5 Is the COG' complete per cooler YE NO <br /> Relinquished a /no Requested analysis es no <br /> S Is the COC' n agreement with the s les received' YES NO <br /> A Samples y no Sample ID's no Date sampled yes/ o <br /> • Matrix yes no I containers a no _ <br /> 7 Are the samvles preserved correctly' YES NO <br /> 8 Is there enough sample for all the requested analyses' S No <br /> 9 Are all samples within holding times for the requested analyses' YES NO <br /> 10 Record cooler temperature Contact PM if temperature as not 4°C t 2°C <br /> Is ice present in cooler' YES NO <br /> 11 Were all sample containers received intact Cie not broken, leaking, © NO <br /> etc )' <br /> 12 Are samples requiring no headspace, headspace free' N/A YES NO <br /> 13 Are VOA lst stickers required' YES O <br /> 14 Ase there special comments on the Chain of Custody which require client YE-1 /A <br /> contact' <br /> 15 If yes, was ATI Project Manager notified' YES <br /> Describe "no" items <br /> Was client contacted' yes / no <br /> If yes, Date Name of Person contacted <br /> Describe actions taken or client instructions- <br /> OC other representative documents, letters, and/or shzpplrg memos <br />