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Rev. 02 Date 07x'19 <br />Sunstar Receiving Form 001 <br />Laboratories. Inc. <br />�„� s - <br />SAMPLE RECEIVING REVIEW SHEET <br />Batch/Work Order #: ZC� 33 7 cl <br />Client Name: M Project: Sfak+o� SM 3 <br />Delivered by: ❑ Client ❑ SunStar Courier X GLS ❑ FedEx ❑ Other <br />If Courier, Received b} : Date;Time Courier <br />Received: <br />Lab Received by: Date;Time Lab <br />paV� Received: <br />Total number of coolers received: Thermometer ID: _SC -1 Calibration due: 8/17/21 <br />Temperature: Cooler 41 1 °C +/- the CF (-0.2°C) = 2 - 8 °C corrected temperature <br />Temperature: Cooler 42 °C +/- the CF (-0.2°C) = °C corrected temperature <br />Temperature: Cooler #3 °C +/- the CF (-0.2°C) = °C corrected temperature <br />Temperature criteria = < VC Within criteria? . Yes ❑No <br />Ano frozen containers <br />If NO: <br />Samples received on ice? ❑Yes ❑No 4 <br />Complete Non -Conformance Sheet <br />If on ice, samples received same day ❑yes Acceptable ❑No 4 <br />collected? Complete Non -Conformance Sheet <br />Custody seals intact on cooler/sample <br />Sample containers intact <br />Sample labels match Chain of Custody IDs <br />Total number of containers received match COC <br />Proper containers received for analyses requested on COC <br />Proper preservative indicated on COC/containers for analyses requested <br />Complete shipment received in good condition with correct temperatures, <br />containers, labels, volumes preservatives and within method specified <br />holding times <br />XYes <br />[7Yes <br />Eyes <br />RjYes <br />Yes <br />[]Yes <br />❑No* <br />❑No* <br />❑No* <br />❑No* <br />[]No* <br />❑No* <br />R] Yes ❑No* <br />❑N/A <br />©N/A <br />* Complete Non-Conformat►ce Receiving Sheet if checked Cooler./ Sample Review - Initials and date: <br />y _ L 3 ` 2_.0 <br />Comments: <br />(949) 297-5020 0 '%N,A-vt.sunstarlabs.com ■ 25712 Commercentre Drivie 0 Lake Forest. CA 92630 <br />