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A[gon Laboratories Sample Receipt Checklist <br /> Client Name: ACT Date&Time Received: 01/14/13 11:23 <br /> Project Name: Dirt Sample 1 Client Project Number: Panella 1 <br /> Received By. SH Matrix: Water ❑ Soil 0 Sludge <br /> Sample Carder Client 0 Laboratory El Fed Ex El UPS El Other El <br /> Argon Labs Project Number: M301020 <br /> Shipper Container in good condition? Samples received in proper containers? Yes 0 No El <br /> NIA Yes F-_/J No ❑ Samples received intact? Yes E No 0 <br /> Samples received under refrigeration? Yes F-,] No E] Sufficient sample volume for requested tests?Yes E No E] <br /> Chain of custody present? Yes ❑ No F1 Samples received within holding time? Yes ❑ No ❑ <br /> Chain of Custody signed by all parties? Yes No ❑ Do samples contain proper preservative? <br /> NIA Yes ❑ No ❑ <br /> Chain of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes 0 No E] (None submitted F11) Yes ❑ No ❑ <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> Date Client Contacted: Person Contacted: <br /> Contacted By: Subject: <br /> Comments- <br /> Action Taken: <br /> ADDITIONAL TEST(S)REQUEST OTHER <br /> Contacted By: Date: Time: <br /> Call Received By: <br /> Comments: <br />