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SAMPLE RECEIPT FORM <br /> Service Request No: P07OO L 3 Client: MW <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 NoSee <br /> ( Comments) <br /> Appropriate sample volume and containers? Yes J No (See Comments) <br /> Sufficient labeling on contamer(s) ? Yes J No (See Continents) <br /> Container(s) supplied by CAS? Yes No (See Comments) <br /> Custody seal(s) intact? N/A Yes No <br /> (See Comments) <br /> Trip Blank(s) received Yes J No <br /> If Trip Blank was supplied by CAS, record serial# <br /> 1 -TB- <br /> Temperature of sample(s))/cooler °C Temp Blanks Y o} N(Circle One) <br /> Voa's Marked Preserved? _Yes J No Filled Properly?Yes �/ N\o--G <br /> (See Comments) <br /> Preserved Bottles Requiring pH check(s)?Yes Appropriate Preservation? Yes No <br /> RUSH Tum around time? Yes Notified <br /> Date&Time <br /> Short Hold-Time Analysis (check all that apply) <br /> ASAP Res CI_ D.O Flash <br /> 24HR H .— Diss S2- Ferrous Fe F&P <br /> P Odor Cr+6 <br /> 48HR BOD Color MBAS Nitrate <br /> Nitrite O-PO4 Sett Sol Turbidity <br /> 72HR Vapors <br /> Notified Date&Time <br /> Container(s) received and their preservative(s): <br /> 0-SMI N (NO � <br /> Comments <br /> 26 <br /> Initials, Date, Time C� J <br /> r:\sr_forms',cooler.doc Rev.2/25/02 <br />