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TEST AMERICA SA MPUE RECEIfP,T LOG <br /> rAirbill: <br /> NT NAME: _ DATE RECD AT LAB: 2� Ute- For Regulatory Purposes? <br /> BY(PRINT) x TIME RECD AT LAB: 2(4;0-- DRINKING WATER YESI(KORDER: DATE LOGGED IN: [p 17-TJO 1 WASTE WATF_R fE I NO <br /> _E THE APPROPRIATE RESPONSE LAB CNTAINER PRESER H SAMPLE OAl'E REMARKS: <br /> SAMPLEf/ CLIENT 1D' DESCRIPTION NATIVE pMATRIX SAMPLED CONDITION(ETC.) <br /> dy Seals) Present! senInt t/Broken" <br /> -of-Custod P Reports or List: Present/ ,e t <br /> Airbill I Stick <br /> Present!A s1t <br /> 4 5. Airbill#- <br /> 6. Sample Labels: Pfeont J Absent <br /> 7..Sample los: st /Not Listed <br /> on Chain-of-Custod <br /> 8. Sample Condition: 1 to J Broken"/ <br /> Lei <br /> a 8. Does Information on chain-of-custody, <br /> traffic reports and sample labels <br /> a .ree? $I No" <br /> 10. Sample received within <br /> hold time? /No" <br /> 11. Adequate sample volume <br /> received? e. !No" <br /> 12• Proper preservatives used? e /Ivo" <br /> 13. Trip Blank/Temp Blank Recelved7 <br /> (cimr,.le which,if es) Yes/ <br /> 314.•Read Temp: <br /> Corrected Temp: <br /> Is corrected (emp 4 +/-2"C? e /No"" <br /> (Accepiance rarTge for samples requiring thermal pres.) <br /> " Exception(if any): METALS / DFF ON ICE <br /> or Problem COC <br /> Rt.Revision 8 "IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> aces Rev 7(07119/05) pays <br /> 49/73/00 <br />