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f a r, It McCampbell Analytical, Inc. "When Oualitv Counts" Q RECEIVED 1534 Willow Pass Road, Pittsburg, CA 94565-1701 FE 016 Toll Free Telephone: (877) 252-9262 / Fax: (925) 252-9269 http://www.imcmWbell.com / E-mail: mam ain@rnccpbell.co ONA NTAL HFAI TW nct�eQ�rll tef rT Sample Receipt Checklist Client Name: GHD and Yes ❑ Date and Time Received: 1/7/2016 16:30 Project Name: Chevron 201383 Yes ❑ No ❑ Date Logged: 1/7/2016 WorkOrder Ng: 1601185 Matrix: Soil No ❑ Water - VOA vials have zero headspace / no bubbles? Received by: Jena Alfaro Carrier: Client Drop -In Sample labels checked for correct preservation? Yes Logged by: Jena Alfaro Chain of Custody (COC) Information Samples Received on Ice? Chain of custody present? Yes �I❑ No ❑ Chain of custody signed when relinquished and received? Yes W1 No ❑ Chain of custody agrees with sample labels? Yes 91 No ❑ Sample IDs noted by Client on COC? Yes 0 No ❑ Date and Time of collection noted by Client on COC? Yes ❑d No ❑ Sampler's name noted on COC? Yes V No ❑ Custody seals intact on shipping container/cooler? Shipping container/cooler in good condition? Samples in proper containers/bottles? Sample containers intact? Sufficient sample volume for indicated test? Sample Receipt Information and Yes ❑ No ❑ Yes 91 No ❑ Yes ❑ No ❑ Yes No ❑ Yes © No ❑ Sample Preservation and Hold Time (HT) Information All samples received within holding time? Yes d❑ No ❑ Sample/Temp Blank temperature Temp: Water - VOA vials have zero headspace / no bubbles? Yes ❑ No ❑ Sample labels checked for correct preservation? Yes ❑V No ❑ pH acceptable upon receipt (Metal: <2; 522: <4; 218.7: >8)? Yes ❑ No ❑ Samples Received on Ice? Yes ❑ No ❑./ NA d❑ NAW NA NA d❑ UCMR3Sam Samples: Total Chlorine tested and acceptable upon receipt for EPA 522? Yes ❑ No ❑ NA V Free Chlorine tested and acceptable upon receipt for EPA 218.7, Yes ❑ No ❑ NA 0 300.1, 537, 539? NOTE: ff the "No" box is checked, see comments below. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — - -------------------------------------------- Comments: Page 17 of 17