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SAMPLE RECEIPT FORM <br /> Service Request No: P060 Client <br /> 's RP <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 Continents) <br /> Sufficient labeling on container(s) ? Yes T No (See Comments) <br /> Container(s) supplied by CAS? Yes,� No (See Comments) <br /> 1 Custody seal(s) intact? N/A Yes <br /> No (See Comments) <br /> Trip Blank(s) received Yes No <br /> If Trip Blank was supplied by CAS, record serial # -TB- <br /> Temperature of samples)/cooler °C Temp Blank. Y r N(Circle One) <br /> Voa's Marked Preserved? Yes J No Filled Properly?Yes V No (See Comments) <br /> Preserved Bottles Requiring 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 /> pP Y) <br /> ASAP 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 I Date&Time <br /> Container(s) received and their preservative(s): <br /> Comments: <br /> I p <br /> � 30 <br /> Initials, Date, Time 1 rAsr forms\cooler.doc Rev.2/25/02 <br />