Laserfiche WebLink
Rev.02 Date 07/19 <br /> Receiving Form 001 <br /> SAMPLE RECEIVING REVIEW STREET <br /> Batch/Work Order#: <br /> Client Name: � Project: �q <br /> Delivered by: ❑ Client ❑ SunStar Courier ® GSO ❑FedEx ❑ Other <br /> If Courier,Received by: Date/Time Courier <br /> Received: <br /> Lab Received by: Date/Time Lab <br /> Received: it-.�•r� ,� �r� <br /> Total number of coolers received: g Thermometer II): Calibration due :6/27/20 <br /> Temperature: Cooler#1 °C+l-the CF(+ 1.2°C) = °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 Within criteria? <br /> no frozen containers) ❑Yes ❑No <br /> If NO: <br /> Samples received on ice? [-]Yes [:]No 4 <br /> Complete Non-Conformance Sheet <br /> If on ice, samples received same day [-]No 4 <br /> collected? ❑Yes 4Acceptable 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 WYes ❑No* <br /> Proper preservative indicated on COC/containers for analyses requested ❑Yes ❑No* MN/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 /> sac, s/..��•e9 <br /> Comments: <br /> Page 1 of 1 <br /> (949)'297-5010 1 1 <br />