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Subcontract Sample Receipt Checklist <br /> i <br /> CLS Work Order Number: <br /> Chain of Custody(COC)Information <br /> Carrier Name (AJ Yes No <br /> Chain of custody present? Yes No <br /> Chain of custody signed when relinquished and received? Yes No <br /> Chain of custody agrees with sample labels? YesNon-Compliant <br /> Sample Receipt Information <br /> Shipping container/cooler in good condition? Yes "` No Not Present <br /> Samples in proper container/bottle? Yes Non-Compliant <br /> Sample containers intact? Yes No <br /> Sufficient sample volume for indicated test? Yes ; No <br /> I <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes El 0 No <br /> Temperature upon receipt: C <br /> Wet Ice present in Cooler? Yes No <br /> Blue Ice present in Cooler? Yes 8 No <br /> i <br /> i <br /> Analytical Requirement Information <br /> Are non-Standard of Modified methods requested? Yes No <br /> Subcontract Lab CERTIFIED for the various methods requested? Yes No <br /> Will Subcontract Lab be able to meet the tum-around time(TAT)requirements? Yes No <br /> Subcontract Lab Information <br /> Work Order Number assigned by Subcontract Lab <br /> Date received at Subcontract Lab <br /> If any items are check marked NO or are non-compliant, a phone call back to California Laboratory Services is required <br /> immediately. If all items are acceptable, a faxed copy of the signed sub chain of custody(COC)and the completed sample receipt <br /> check list is required within 24 hours of sample receipt. <br /> California Laboratory Services 3249 Fitzgerald Road Rancho Cordova,CA 95742 Phone(916)638-7301 Fax(916)638-4510 <br /> Page 9 of 10 <br />