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MONTROSE Msaciutut Laburrtorics <br /> ,,. <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Section 1 ' <br /> Client: C_JJ''''N� Q �`{�D ��� Project: <br /> Date Received: Sampler's Signature Present: Yes No <br /> Sample temperature: — <br /> Sample(s)received in cooler: Ye 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: <br /> 7/ '' (Areeptance iange is 0 to G Deg. C.orar7ival orr ice; <br /> F-o,- rant le<_10 Deg, arrival On ice <br /> YES NO N/A <br /> Section 3 <br /> Was a COC received? <br /> Were IDs resent? <br /> Were sampling dates&times present? f <br /> Was a signature. resent? <br /> Were tests cleanX indicated? <br /> Were custody seals resent? <br /> If Yes—were they intact? <br /> Were all samples sealed in lastic bags? <br /> Did all samples arrive intact?If no,indicate below. <br /> Did all bottle labels agree with COC? D,dates and times) J <br /> Were correct containers used for the tests required? <br /> Was a sufficient amount of sample sent for tests indicated? <br /> Was there heads ace in VOA vials? <br /> Were the containers labeled with correct preservatives? <br /> Was total residual chlorine measured(Fish Bioassay samples only)? <br /> *If the answer is tzo,pleaje.inform Fisb Bioassay Dept, immediate! <br /> Y. <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: <br /> Date: <br /> Associated Laboratories of Montrose Environmental Group,fnc- <br /> 806 V.Batavia Strcet,Orange,CA 92568•T:(714)771-6900•R:(714)771-9933 Page t <br /> ��n�w.associatcdlabs.co m <br />