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1 <br /> 70, IK <br /> 6 .iso i-':t , N ' 'r OL .R � J ' <br /> 1 <br /> -AN A, LYTICAJIL <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Section 1 <br /> Client;Department of Toxic Substances - Project:t8EA0051 <br /> Date Received;12/6/18 Sampler's Name Present: ✓ es No <br /> Section 2 <br /> Sample Temp rQ - <br /> Sample(s)received in a cooler? ❑J Yes,How many? 1 E]No(skip section 2) (No coder) <br /> Sample Temp('C),One from each cooler: #1: 3.8 #2: #3: #4: <br /> (Acceptance range is<6-Cbut notfrozen(for Mtcrobtalogysamples acceptancerwyels<I4'Chvtnotfroten). hisocceptableforsamplescoffeded <br /> die same day assample receipt to have a higher temperature as tong as there isevidencethat tooting hasbegun.) <br /> Shipping Information: <br /> Section 3 <br /> Was the cooler packed with: Ice ✓ ce Packs BubbleWrap ❑St rofoam <br /> p Paper None Other p Y <br /> Cooler Temp(°C): #1: 5.9 #2: #3: #4: <br /> Section 4 YES NO N/A <br /> Was a COG received? ✓ ;i <br /> Are sample IDs present? ✓ <br /> Are sampling dates&times present? - J 77, i <br /> Is a relinquished signature present? ✓ <br /> Are the tests required clearly indicated on the COC? ✓ <br /> Are custody seals present? J <br /> if custody seals are present,were they intact? ✓ <br /> Are a8 samples sealed in plastic bags? (Recommended for Microbiology samples) ✓ <br /> x <br /> Did all samples arrive intact?If no,indicate in Section 4 below.- ✓ <br /> Did all bottle labels agree with COC?(ID,dates and times) ✓ <br /> Were the samples collected in the correct containers for the required tests? ✓ <br /> Are the containers labeled with the correct preservatives? . ✓ <br /> Is there headspece in the VOA vials greater than 5-6 mm in diameter? ✓ <br /> Was a sufficient amount of sample submitted for the requested tests? ✓ <br /> Section S Explanations/Comments <br /> Section 6 <br /> For discrepancies, how was the Project Manager notified?❑verbal PM initials Date/time <br /> [-]Email (emaitsent to/onl;_/ <br /> Project Manager's response; <br /> Completed By: i-" Date. <br /> EnthaipyAnaWni,s wbsidiaryafMontrose Emfttanental Group,tnc <br /> 931 W.Barkley Ave,I)mng%CA 92868•T.(714)771-6900•R(714)538-1249 <br /> w .enthalpKcomfsocal <br /> Sample Acceptance Cheddist—Rev 4,8/8/2017 <br />