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SAMPLE RECEIPT FORM <br /> Service Request No: P070 �2 Client: <br /> 4A� <br /> I f <br /> Sample(s) delivered by: Client CAS Emp After Hours DHL <br /> Golden State Overnight Fed X UPS Other Courier <br /> Chain of Custody filled out accurately? Yes No (See Comments) <br /> Appropriate sample volume and,containers? Yes / No (See Comments) <br /> Sufficient labeling on container(s) ? Yes V No (See Comments) <br /> Container(s) supplied by CAS? r Yes No - (See Comments) <br /> Custody seal(s) intact? N/A r/ Yes No (See Comments) <br /> Trip Blank(s) received Yes No <br /> Trip was Blank supplied by CAS Yes No <br /> pP <br /> Record serial 9' -TB- <br /> Temperature of samples)/cooler °C Temp Blank? Y (r N ircle One) <br /> ` Voa's Marked Preserved?j Yes V/ No Filled Properly? Yes j No (See Comments) <br /> Preserved Bottles Re9 buirinv pH check(s)? Yes Appropriate Preservation? Yes No <br /> RUSH Turn around time? Yes Notified Date`&Time <br /> Short Hold-Time Analysis (check all that apply) <br /> IASAP Res Cl D.O Flash Diss S2- Ferrous Fe <br /> 24HR pH Odor Cr+6 <br /> 48HR BOD Color MBAS Nitrate <br /> Nitrite O-PO4 Sett Sol Turbidity <br /> 72HR Vapors <br /> Notified, Date &Time <br /> IContainer(s) received and their preservative(s): <br /> ---,SODS l NP ) <br /> 1 <br /> I <br /> Comments <br /> 26 <br /> r r73 <br /> Initials, Date, Time =74 \SMO\LOGFORMS\COOLER.DOC <br />