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•' I <br /> CHROMALAB, INC. <br /> Envircnmontal Service(SDB) <br /> Sample Receipt Checklist <br /> Client Name Date/Time Received- 07/29/97 <br /> Reference/Submis 34855 7 7375 ece ved by <br /> Checklist completed by � � Reviewed by <br /> 4 Al 7 <br /> Signature Date Initials I Date <br /> Matrix: ( Carrier name=Client <br /> Not <br /> Shipping container/cooler in good condition? Yes No Present <br /> Not <br /> Custody seals intact on shipping container/cooler"> Yes No Present <br /> Not <br /> Custody seals intact on sample bottles? Yes No Present <br /> Chain of custody present? Yes No <br /> Chain of custody signed when relinquished and received? Yes No <br /> Chain of custody agrees with sample labels? Yes No <br /> Samples in proper container/bottles Yes <br /> No <br /> le containers intact? Yes No <br /> Sufficient sample volume for indicated test'-' Yes No <br /> All samples received within holding time? / J Yes No <br /> Container/Temp Blank temperature in compliance? Tempy 'C Yes No <br /> Water - VOA vials have zero headspace? No VOA vials submitted / Yes No <br /> Wer - pH acceptable upon receipt:? Adjusted? Checked by <br /> chemist for VOAs <br /> Any No and/or NA (not applicable) response must be detailed in the comments section below. <br /> Client contacted Date contacted: Person contacted: <br /> Contacted by: Regarding: <br /> comments: J /L{ �LL (J �' C c. C r �� l �� 3 � f� •� fir'/ iJ����� <br /> Orective Action: <br />