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MONTROS E A>SPC PtCll t P�UN�Pfil•S <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Section 1 K er(] DO Project: <br /> Client: <br /> Date Received: i j Sampler's Signature Present• es o <br /> W�^� <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: Ice Ice Packs —Bubble Wrap —Styrofoam <br /> Paper None ._Other <br /> Cooler Temperature: (Ac,ptance range it 0 to 6 Deg. C oraniyal 011 ice; <br /> For Miawhi010JTWO<10 De. C or arrival oar ice ;j S NO N/A <br /> Section 3 <br /> Was a COC received? <br /> Were IDs resent? <br /> Were sampling dates&times resent? <br /> Was a signatw a resent? <br /> Were tests clearly indicated? <br /> Were custody seals resent? <br /> If Yes—were the intact? ✓ <br /> Were all samples 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 t/ <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 /> Was total residual chlorine measured(Fish Bioassay samples only)? <br /> *If the answer is no,please ily orm Fish Bioangy Dept immediate!. „ <br /> Section 4 <br /> Explanations/Comments . <br /> 44 <br /> Section 5 <br /> Was Project Manager notified of discrepancies: Y / N N/A <br /> Project Managees response: <br /> Completed By: A Date: C� <br /> Associated Laboratories of Montrose Environmental Group,Inc. <br /> 806 N.Batavia Street,Orange,CA 97868•'C:(714)771-6900•F:(714)771-9933 "age� 1 <br /> www.assoeiatedlabs.com <br />