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SI'L Fullerion 1?nvironrneWal Laboratory <br /> sample Receiving Checklist <br /> FSC Workorder Number: 9 7 -U--.O 9 9 <br /> Date: q �g ATime: 1123-0 <br /> Yes No NIA <br /> I. Chain of Custody Record I'resellt'l Y + <br /> 2,- Chain of Custody Record Properly Completed? � + <br /> I Custody Seals on Shipping Container? <br /> 4. Custody Seals on Sample Container? <br /> 5. All Custody Seals Intact? <br /> G. All Sainples Received intact? <br /> 7. All Swnples Labeled Correctly? <br /> 8. Samples are Chilled at 2°C - G°C <br /> * See Non-Conformance/ Sample Condition Notification Fond only if box Nvith "' is chcck-ed. <br /> Internal Temperature of Shipping Container °C <br /> Samples Were Delivered by: Name/Tracking Number: <br /> SPL Courier <br /> Client Representative <br /> Federal Express <br />' UPS <br /> DHL <br /> Other: <br /> All samples will be disposed 30 gays from the report date for this workorder, unless <br /> otherwise specified by the Client. <br /> . 7 <br /> Samples Checked by: GO <br /> ladataWor ms\Iogi nc hk.tk pd <br />