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cCampbell Analytical, IIIc. 1 1534 Willow Pass Road, Pittsburg, CA 94565-1701 Web: www.mccampbell.com E-mail: main@mccampbell.com "When Oualitv Counts" Telephone: 877-252-9262 Fax: 925-252-9269 Custody seals intact on shipping container/cooler? Shipping container/cooler in good condition? Samples in proper containers/bottles? Sample containers intact? Sufficient sample volume for indicated test? Samole Receipt Information Yes ❑ Sample Receipt Checklist Client Name: Forward Landfill No ❑ Yes ® Date and Time Received: 10/17/08 9:44:32 AM Project Name: Forward Landfill Stain on the ground No ❑ Checklist completed and reviewed by: Maria Venegas WorkOrder N°: 0810415 Matrix Soil ❑ No ❑ No VOA vials submitted Carrier: UPS Yes Chain of Custody (COC) Information Chain of custody present? Yes ® No ❑ Chain of custody signed when relinquished and received? Yes 21 No ❑ Chain of custody agrees with sample labels? Yes ® No ❑ Sample IDs noted by Client on COC? Yes ® No ❑ Date and Time of collection noted by Client on COC? Yes ® No ❑ Sampler's name noted on COC? Yes ® No ❑ Custody seals intact on shipping container/cooler? Shipping container/cooler in good condition? Samples in proper containers/bottles? Sample containers intact? Sufficient sample volume for indicated test? Samole Receipt Information Yes ❑ No ❑ Yes ® No ❑ Yes ® No ❑ Yes ® No ❑ Yes ® No ❑ Sample Preservation and Hold Time (HT) Information All samples received within holding time? Yes ® No ❑ Container/Temp Blank temperature Cooler Temp: NA Water - VOA vials have zero headspace / no bubbles? Yes ❑ No ❑ No VOA vials submitted Sample labels checked for correct preservation? Yes ® No ❑ TTLC Metal - pH acceptable upon receipt (pH<2)? Yes ❑ No ❑ NA Samples Received on Ice? Yes ❑ No ' NOTE': If the "No" box is checked, see comments below. Client contacted: Date contacted: Contacted by: Comments: