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MONT&OSE Associated L0.horatarits <br /> : 1 is tl:!M F N i A[ f Imwe••IMd,NMS•n4n <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Section <br /> Client: �� OOH Project <br /> Date Received: i Sampler's Signature Present• es o <br /> Sample temperature: <br /> Sample(s)received in cooler: es No (Skip Section 2) <br /> Shipping Information: <br /> Section 2 <br /> Was the cooler packed with: VIce Ice Packs _Bubble Wrap —Styrofoam <br /> �j Q___Paper None —Other <br /> Cooler Temperature: �� Otvotance range is 0 to G Deg. C. ara)rival on ice; <br /> ror Miobbiolo,Usai;iple:51ODegCoranib,alonice <br /> Section 3 YES NO N/A <br /> Was a COC received. <br /> Were ID <br /> s resent? <br /> Were sampling dates&times resent? <br /> Was a signature resent? t/ <br /> Were tests clearly indicated? <br /> Were custodv seals resent.? <br /> If Yes—were they intact? <br /> Were all samples sealed in plastic bags? <br /> Did all samples arrive intact?If no,indicate below. v <br /> Did all bottle labels agree with COC? ,dates and times <br /> Were correct containers used for the tests re uired? <br /> Was a sufficient amount o£sample sent for tests indicated? <br /> Was there heads ace in VOA vials? <br /> Were the containers labeled with correctpreservatives? <br /> Was total residual chlorine measured(Fish Bioassay samples only)? <br /> *I the answer is no,please h!orm Fisb Bioassay Dept.immediate)• <br /> Section 4 <br /> Explanations/Comments <br /> Section 5 <br /> Was Project Manager notified of discrepancies: Y / N N/A <br /> Project Manager's response: <br /> Completed By: Date C 1 <br /> Associated Laboratories of Montrose Environmental Group,Inc 3 <br /> 806 N7.Batavia Street,Orange,CA 92868•T:(714)771-6900•p:(714)771-9933 <br /> www.usociatedlabs.com Page 1 <br />