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Zoko ] E T AL .�A .NALY TIC . AL <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Sectlon1 <br /> Client:callfamia Department of Toxic Substance Control Project,18EA0051 <br /> Date Received:11130/18 Sampler's Name Present. ✓ es No <br /> Section 2 SampleTemP VC) <br /> Samples) r ceived in a cooler? Q✓1'es,How many? 1 nNo(sktpsactronz) (No Coder)�— <br /> Sample Temp("C),One from each cooler: #1: 3.8 #2: #3: #4: <br /> (Aaeptonce r age is<6'C but notfrazen fforMiaobkdogysampim acceptance rage is<10°Gbtx mtfrozen). Itis acceptahk forsampks collected <br /> the same day msample teceiptto have ahigher temperature m larg as there isevfde w Mot coolkghm begum) <br /> Shipping in ormation: <br /> Section 3 <br /> Was the co i ler packed with: ✓ ice ✓ ce Packs Bubble Wrap QStyrofoam <br /> Paper None Other <br /> Cooler Temp(°C): #1: a-o #2: #3: #4: <br /> Section 4 I YES NO N/A <br /> Was a GOC eceived? ✓ �� <br /> Are sample IDs present? <br /> Are sampling dates&times present? ✓ ` <br /> Is a relinquished signature present? ✓ j <br /> Are the test's required clearly indicated on the COC? 1( 7723377 <br /> Are custody seals present? <br /> ✓ : <br /> If custody seals are present,were they intact? ✓ <br /> [Diid <br /> all samples sealed in plastic bags? (Recommended for Microbiology samples) ✓ <br /> all samples arrive intact?If no,indicate.in Section 4 below. ✓ <br /> all bottle labels agree with COC?(ID,dates and times) ✓ " <br /> re the samples collected In the correct containers for the required tests? ✓ <br /> Are th'e containers labeled with the correct preservatives? ✓ ✓ <br /> here headspace in the VOA vials greater than 5-6 mm in diameter?s a suffi lent amount of sample submitted for the requested tests? ✓ <br /> Section S Explanations/Comments <br /> Sample 4 "TCS-04" was received broken. The sample can be salvaged from the cooler. <br /> v <br /> Section 6 <br /> For discrepancies,how was the Project Manager notified?OVerbal PM Initials:_ Date/rime <br /> ❑Email (emailserttto/on):—/ <br /> Project Manager's response: <br /> Completed I3 y:_ i� - Date: <br /> Enthalpy Awhticat a u"dary of Montrose Erntronrawtal Group,inc <br /> 931 W.earldey Ave,orange,CA 92868•T:(714)771-6900•F.(714)538-1204 <br /> w Xnthalpycom/soul <br /> . Sample Acceptance awcklkt—Rev 4,8/8/2017 <br />