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Rev.02 Date 07/19 <br /> k Receiving Form 001 <br /> SAMPLE RECEIVING REVIEW SKEET <br /> Batch/Work Order#: T 19 3 9. <br /> Client Name: Zwti cap Z-o.�,+ Project: <br /> Delivered by: ❑ Client ❑ SunStar Courier [ GSO ❑FedEx ❑ Other <br /> If Courier,Received by: Date/Time Courier <br /> Received: <br /> Date/Time Lab <br /> Lab Received by: Received: l ! f I <br /> 1 Yves - 9 <br /> Total number of coolers received: Thermometer ID: SG_. ( Calibration due : :6/27/20. <br /> Temperature: . Cooler#1 1 °C+/-the CF(+1.2°C) = t .3 °C corrected temperature <br /> Temperature: . Cooler#2 -°C+/-the CF(+ 1.2°C) _ °C corrected temperature. <br /> Temperature: Cooler#3. °C+/-the CF(+ 1.2°C) = °C corrected temperature <br /> Temperature criteria=5 6°C . <br /> no frozen containers) V�ithin criteria?. [ Yes []No <br /> If NO: . <br /> ❑NoSamples received on ice? ❑Yes. <br /> ' Complete Non-Conforinance Sheet <br /> If on ice,samples received same day. ❑No <br /> collected? ❑Yes Acceptable. Complete Non-Conformance Sheet <br /> Custody seals intact on cooler/sample ❑Yes ❑No* N/A <br /> Sample containers intact [✓]Yes ❑No*. <br /> Sample labels match Chain of Custody IDs ❑Yes ❑No* <br /> Total number of containers received match COC. dyes ❑No* <br /> Proper containers received for analyses requested on COC ✓❑Yes ❑No* <br /> Proper preservativee indicated on COC/containers for analyses requested ❑Yes [-]No* JEN/A <br /> Complete,shipment received in good condition with correct temperatures, <br /> containers;labels,volumes preservatives and within method specified ❑/Yes []No* <br /> holding times <br /> Complete Non-Conformance Receiving Sheet if checked Cooler/Sample Review-Initials and date: <br /> .Comments: .... .. <br /> Page 1 of J <br /> 949) 297-5020 0 www.sunstarlabs.corn .92263G <br />