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V:` j A <br /> MONTROSE Accaeiated Laboratari" <br /> r..u.....au..y.an r..a... <br /> t`:I'tl <br /> SAMPLE ACCEPTANCE CHECKLIST ._/ <br /> 3 � <br /> Section Z I_JJ//,, /,�- <br /> Client: Cv�� ® A6470 0101'e Project: <br /> Date Received: Sampler's Signature Present: Yes No <br /> Sample temperature: <br /> Samples)received in cooler: Ye No (Skip Section 2) <br /> Shipping Information: <br /> Section 2 ' <br /> Was the cooler packed with: y Ice Ice Packs _Bubble Wrap _Styrofoam <br /> 9 Paper None _Other <br /> Cooler Temperature: <br /> 2/ (Acceptaiice wqe is 0 to 6 Deg. C.or aminal m ice; <br /> ForMicmbiolo ram !e<_ i0 De. Corairiaalon lee ) YES NO N/A <br /> Section 3 <br /> Was a COC received? <br /> Were IDs resent? <br /> Were sampling dates&times resent? <br /> Was a signature resent? <br /> Were tests clearly indicated? <br /> Were custody seals resent? <br /> — <br /> If Yes—were they intact? <br /> Were all sam les sealed in plastic bags? <br /> Did all samples arrive intact?If no,indicate below. <br /> Did all bottle labels agree with COC? D,dates and times) <br /> Were correct containers used for the tests required? <br /> Was a sufficient amount of sam le sent for tests indicated? <br /> Was there heads ace in VOA vials? <br /> Were the containers labeled with correctpreservatives? <br /> Wastotal residual chlorine measut ed(Fish Bioassay samples only)? <br /> *If tlje answer is no,please iq form Fish Bioassay Dept immediatel- <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: <br /> Associated Laboratories of Montrose Environmental Group,Inc. <br /> 806 N.Batavia Street,Orange,CA 93868•T:(714)771-6900•f:(714)771-9933 page 1 <br /> %%n%,v.associa tcdlabs.com <br />