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SAMPLE RECEIPT CHECKLIST Pk;Section 1: Login# I �c Client: <br /> Date Received:�f = i l t"t 3 rt,l'Y <br /> Project: <br /> Section 2: Samples received in of oo�ler? ❑ Yes, how many? o(skip Sectio 3 below) <br /> If no cooler Sample Temp(°C): ZT5 �7 using IR Gun# ❑ A, or B <br /> ❑Samples received on is direct) from <br /> p y t feel Cooling process had begun � <br /> If in cooler: Date Opened y <br /> (print) <br /> ) (sign) <br /> Shipping info(if applicable) <br /> Are custody seals present? No,or❑Yes. If yes,where? ❑on cooler, ❑ on samples, ❑on package <br /> ❑ Date: How many ❑Signature, ❑ Initials, None <br /> Were custody seals intact upon arrival? ❑Yes ❑No N/A <br /> Section 3: Important: Notify PM if temperature exceeds 6°C or arrive frozen. <br /> Packing in cooler:(if other, describe) <br /> ❑ Bubble Wrap, ❑ Foam blocks, ❑ Bags, ❑ None, ❑Cloth material, ❑Cardboard, ❑Styrofoam, ❑ Paper towels <br /> ❑Samples received on ice directly from the field.Cooling process had begun <br /> Type of ice used : ❑ Wet, ❑ Blue/Gel, ❑ None Temperature blank(s)included? ❑ Yes, ❑ No <br /> Temperature measured using ❑Thermometer ID: or IR Gun# ❑ A ❑ B <br /> Cooler Temp(°C):#1: #2: #3: #4: #5: #6: #7: <br /> Section 4: YES NO N/A <br /> Were custody papers dry,filled out properly,and the project identifiable ==. <br /> Were Method 5035 sampling containers present? <br /> If YES,what time were they transferred to freezer? rs- d, <br /> � . _ <br /> Did all bottles arrive unbroken/unopened? to <br /> Are there any missing/extra samples? <br /> Are samples in the appropriate containers for indicated tests? <br /> Are sample labels present, in good condition and complete? <br /> Does the container count match the COC? <br /> Do the sample labels agree with custody papers? �- <br /> Was sufficient amount of sample sent for tests requested? <br /> Did you change the hold time in LIMS for unpreserved VOAs? �. <br /> Did you change the hold time in LIMS for preserved terracores? <br /> Are bubbles>6mm absent in VOA samples? �- <br /> Was the client contacted concerning this sample delivery? <br /> If YES,who was called? By Date: I, <br /> Section 5: YES NO N/A <br /> Are the samples appropriately preserved? (if N/A,skip the rest of section 5) <br /> Did you check preservatives for all bottles for each sample? t ,ft <br /> Did you document your preservative check? f , <br /> pH strip lot# pH strip lot# ,pH strip lot# <br /> Preservative added: <br /> ❑ H2SO4 lot# added to samples on/at <br /> ❑ HCL lot# added to samples on/at <br /> ❑ HNO3 lot# added to samples on/at <br /> ❑ NaOH lot# added to samples on/at <br /> Section 6: <br /> Explanations/Comments: <br /> Date Logged in G By(print) (sign) <br /> Date Labeled C.( 61 By(print) (sign) <br /> Enthalpy Analytical-Berkeley Rev.15,02/02/2018 <br /> 5of30 <br />