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McCampbell Analytical, Inc. <br />"When Ouality Counts" <br />RECEIVED <br />FES• <br />16 <br />1534 Willow Pass Road, Pittsburg, CA 94565-1701 <br />Toll Free Telephone: (877) 252-9262 / Fax: (925) 252-9269 Vf Rel NTAL <br />http://www.mccampbell.com / E-mail: main(ufnccamC" <br />pbell-�iV1 <br />Sample Receipt Checklist <br />Client Name: GHD <br />and <br />Yes ❑ <br />Date and Time Received: <br />1/7/2016 16:30 <br />Project Name: Chevron 201383 <br />Yes 91 <br />No ❑ <br />Date Logged: <br />1/7/2016 <br />WorkOrder Ne: 1601183 Matrix: Soil <br />No ❑ <br />Water - VOA vials have zero headspace / no bubbles? <br />Received by: <br />Jena Alfaro <br />Carrier: Client Drop -In <br />Sample labels checked for correct preservation? <br />Yes <br />Logged by: <br />Jena Alfaro <br />Chain of <br />Custody <br />(COC) <br />Information <br />Samples Received on Ice? <br />Chain of custody present? <br />Yes <br />❑ <br />No ❑ <br />Chain of custody signed when relinquished and received? <br />Yes <br />❑ <br />No ❑ <br />Chain of custody agrees with sample labels? <br />Yes <br />❑ <br />No ❑ <br />Sample IDs noted by Client on COC? <br />Yes <br />No ❑ <br />Date and Time of collection noted by Client on COC? <br />Yes <br />No ❑ <br />Sampler's name noted on COC? <br />Yes <br />© <br />No ❑ <br />Custody seals intact on shipping container/cooler? <br />Shipping container/cooler in good condition? <br />Samples in proper containers/bottles? <br />Sample containers intact? <br />Sufficient sample volume for indicated test? <br />Sample Receipt Information <br />and <br />Yes ❑ <br />No ❑ <br />Yes ❑d <br />No ❑ <br />Yes 91 <br />No ❑ <br />Yes <br />No ❑ <br />Yes ❑ <br />No ❑ <br />Samole Preservation <br />and <br />Hold Time <br />(HT) Information <br />All samples received within holding time? <br />Yes <br />9 <br />No ❑ <br />Sample/Temp Blank temperature <br />Temp: <br />Water - VOA vials have zero headspace / no bubbles? <br />Yes <br />❑ <br />No ❑ <br />Sample labels checked for correct preservation? <br />Yes <br />d❑ <br />No ❑ <br />pH acceptable upon receipt (Metal: <2; 522: <4; 218.7: >8)? <br />Yes <br />❑ <br />No ❑ <br />Samples Received on Ice? <br />Yes <br />❑ <br />No d❑ <br />NA ❑d <br />NA❑ <br />NA ❑d <br />NA ❑d <br />UCMR3UCMR3 Samples: <br />Total Chlorine tested and acceptable upon receipt for EPA 522? Yes ❑ No ❑ NA 0 <br />Free Chlorine tested and acceptable upon receipt for EPA 218.7, Yes ❑ No ❑ NA 91 <br />300.1, 537, 539? <br />" NOTE. If the "No" box is checked, see comments below. <br />--------------------------------------------- <br />--------------------------------------------- <br />Comments: <br />Page 20 of 20 <br />