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SAMPLE RECEIPT CHECKLIST <br /> Section 1: Login# Client: G hey- Lr <br /> A [N"FHALP <br /> Date Received: 2 3 Project:TqNyX 3 — G�1MEi✓ <br /> Section 2: Shipping info(if applicable) <br /> Are custody seals present? ❑ No,or;;ryes. If yes,where?JVon cooler, ❑on samples, ❑on package <br /> ❑ Date: 12 130 How many I ;2'Signature,❑ Initials,❑None <br /> Were custody seals intact upon arrival? 'Yes ❑No ❑ N/A <br /> Samples received in a cooler?/21 Yes,how many? ❑No(skip Section 3 below) <br /> If no cooler Sample Temp('C): using IR Gun# , or ❑ C <br /> ❑Samples received on Ice directly from the J field..Cooling process ha begun <br /> If in cooler:Date Opened . 3 By(printf 13Y'! (sign) <br /> Section 3: Important:Notify PM If temperature exceeds 6'C or arrive frozen. <br /> Packing in cooler:(if other,describe) <br /> ubble Wrap,❑Foam blocks, 713ags, ❑ None,❑Cloth material,❑Cardboard,❑Styrofoam, ❑ Paper towels <br /> ❑Samples receivedo ce directly from the field.Cooling process had begun <br /> Type of ice used: Wet, ❑ Blue/Gel, ❑ None Temperature blank s)included? Yes, ❑ No <br /> Temperature measured using ❑Thermometer ID: or IR Gun# B ❑ C <br /> Cooler Temp(°C):#1: #2: #3: #4: #5: #6: #7: <br /> Section 4: YES NO N/A' <br /> Were custody papers dry,filled out properly,and the project identifiable <br /> Were Method 5035 sampling containers present? <br /> If YES,what time were they transferred to freezer? IE <br /> Did all bottles arrive unbroken/unopened? <br /> Are there any missing/;extra samples? <br /> Are samples in the appiropriate containers for indicated tests? <br /> Are sample labels present,in good condition and complete? <br /> Does the container count match the COC? <br /> Do the sample labels agree with custody papers? <br /> Was sufficient amount of sample sent for tests requested? . <br /> Did you change the hold time in LIMS for unpreserved VOAs? <br /> Did you change the hold time in LIMS for preserved terracores? <br /> Are bubbles>6mm present in VOA samples? <br /> Was the client contacted concerning this sample delivery? <br /> If YES,who was called? By Date: <br /> Section 5: <br /> YES tO <br /> Are the samples appropriately preserved? (if N/A,skip the rest of section 5) <br /> Did you check preservatives for all bottles for each sample? <br /> Did you document your preservative check? <br /> pH strip lot# pH strip lot# pH strip lot# <br /> Preservative added: <br /> ❑H2SO4 lot# added to samples on/at <br /> ❑ HCL lot# added to samples on/at <br /> ❑HNO3 lot# added to samples on/at <br /> ❑NaOH lot# added to samples on/at <br /> Section 6: <br /> Explanations/Comments: <br /> Date Logged in .2 By(print) (sign) <br /> Date Labeled i L By(print) �> (sign) <br /> Enthalpy Analytical-Berkeley Rev.15.1,09/13/2019 <br /> Page 39 of 49 1/V&014 <br />