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171 or <br /> LAN <br /> ASSOCIATED LABORATORIES <br /> 806 North Batavia—Orange, California 92868— 714-771-6900 FAX 714-538-1209 <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Section a <br /> Client: Project: <br /> Date Received: V11 /k N Sampler's Name: Yes <br /> Sample(s)received in cooler: (Yes) 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 or box temperature: 14--C <br /> (Acceptance range is 2 to 6 Deg. C.) <br /> Section 3 YES NO N/A <br /> Was a COC received? V <br /> Is it properly completed? (IDs, sampling date and time, signature,test) V <br /> Were custody seals resent? <br /> If Yes—were they intact? <br /> Were all samples sealed in plastic bags? u <br /> Did all samples arrive intact? If no,indicate below. <br /> Did all bottle labels agree with COC? ID, dates and times <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 carrect preservatives? � <br /> Was total residual chlorine measured(Fish Bioassay samples only)? <br /> *: If the answer is no, please inform Fish Bioassay Dept. immediately. <br /> Section 4 <br /> Explanations/Comments <br /> Section 5 <br /> Was Project Manager notified of discrepancies: Y / N N/A <br /> Completed By: f{ _ Date: l l t 1 <br />