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CALWORN1.A DEPARTMENT OF,ro 1C SUBSTfi KES CONTROL, <br /> Environmental Chemistry Laboratory - <br /> 700 Heinz Avenue,Suite#150, Berkeley,CA 94710 <br /> Phage:(510)540-3131 snmffCathso.ca.gov <br /> SAIVIM RECEI,PTCREC,K'LIS <br /> Authorization Number: 00,T1 Date Received: 14/2.4Il8 <br /> ECL Na.:t(OfFO2 . d'K0086 S Time deceived: A <br /> Sample Checklist Criteria: Dart I Yes No <br /> 1. Sample Analysis Request(SAR)received with the sample(s)? <br /> 2. Sample received with proper preservation and information? <br /> 3, Chain of Custody complete? Names printed? Signed and Dated? <br /> 4. Samples)received in a cooler/ice chest with icelblue ice? ' <br /> 5. Temperature of sample within 5 6"C? Observed Temp:C1,`L °C v' <br /> 6. Confirm prioritization list of Test Methods with requestor? <br /> Sample Checklist Criteria; Part II <br /> 7, Custody seal present and intact? <br /> S. Sample condition acceptable (intact and no damage)? <br /> 0. Container size as noted on SAR? ✓ <br /> 10. Do the number of samples on SAR and the number of samples on , <br /> ARF a ree? Are they within 20%range? <br /> 11. Aqueous and liquid samples in 40 mL"VOA vials and no head space? WA <br /> 12. Is there sufficient sample amount/volume for all analyses? II10 <br /> see SOP on Environmental Sam le Receipt, Handlin and Coo) <br /> 13. Do sample labels agree with SAR? <br /> 14. Are sample labels legible? <br /> 15. Are samples received in proper containers? (see SOP on Environmental .� <br /> Sample Receipt,Handling and CoC <br /> 16. If received by FedEx or UPS is Air bill/packing sip signed and dated? t4 <br /> 17. If supplemental analysis is requested, is it specified in Section 12 of SAR? <br /> 18. Did the Requester initial& date Section 12 of SAR? v <br /> Non-acceptable discrepancies mentioned above were communicated to Requestor/Transporter: <br /> In Person:—Date: By Phone:`.Date;. _ ByEmail: Date: <br /> Comments: <br /> Name: _ r_4% -010 .3,1vo% Signature: '"�4 Date: 49-I <br /> Supervisor's Approval (if any corrective action taken): Date: <br /> DCN: 07,0071,00—Revision 2-11/6/2018—Approved by QM0 Page 1 of 1 <br /> paae 10 of 13 <br />