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ASSOCIATED LABORATORIES <br /> 806 North Batavia—Orange, California 92868— 714-771-6900 FAX 714-538-1209 <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Section 1 <br /> Client _r " �► Protect TLC 17) <br /> Date Received_ p/z q t�s <br /> Sample(s)received in coolerest- No (Sk12 Section 2 <br /> Section 2 <br /> Was the cooler packed with: y-'Ice Ice Packs Bubble Wrap Styrofoam <br /> Paper None Other <br /> Cooler or box temperature: i{' <br /> (Acceptance range is 2 to 6 Deg C} <br /> Section 3 YES NO NIA <br /> Was a COC received9 <br /> Were custody seals resent? <br /> If Yes—were they intact9 , <br /> Were all samples sealed in plastic ba 9 <br /> Did all nm les arrive intact? If no,indicate below ,.- <br /> Did all bottle labels agree with COC? (11),dates and times) °- <br /> Were correct containers used for the tests required? <br /> Was a sufficient amount of sample sent for tests indicated9 <br /> No heads ace in VOA vials9 �. <br /> Were the correct preservatives used? <br /> Were the samples scanned for presence of radtoactivit ! <br /> Section 4 <br /> Explanations/Comments <br /> Section 5 <br /> Was Project Manager notified of discrepancies Y / <br /> • Completed By (MK Date- 3'f�S- <br />