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SAMPLE RECEIPT CHECKLIST <br /> Section 1:General Info `a �Date Received: 2/r T AV WOa 5 y6 /C i Client: /2"1C Ivinvi <br /> Section 2:Shipping/Custody Are custody seals present?❑Yes 7NO <br /> Custody seals intact on arrival? )IN/A ❑Yes ❑No ❑on cooler/box ❑on samples <br /> ❑Courier ❑Walk-In ❑Field Sampling R04ping Info: F=�CV cg <br /> Section 3a:Condition/Packaging ❑ Outside 0.0-6.0-C(0.0-10.0•C for microbiology)(PM notified) <br /> Date Opened 1 f 3/Z s' By(initials) rr� Type of ice used: ❑ Wet ❑Blue/Gel ❑None <br /> ❑Samples received on ice directly from the field;cooling process had begun.(if checked,skip temperatures) <br /> ❑Sample matrix doesn't require cooling(e.g.air,bulk PCB).(if checked,skip temperatures) <br /> If no cooler:Observed/Adjusted Temp(Y): / Thermometer/IR Gun: n i r OF: t" <br /> Cooler temp('C)#1:_y r / y._L a2:�_#3:____J_a4:— 115: a6:___/_ <br /> Section 3b:Microbiology Samples ZNo microbiology samples submitted(skip 3b) <br /> ❑ Within temp range0.0-30.0•Cor received on icedirectly from field. <br /> O Adequate headspace for microbiology analysis. <br /> Section 3c:Air Samples FfNa air samples submitted(skip 30 <br /> ❑1.41-Canisters ❑6L Canisters ❑Tedlar Bags ❑MCE Cassettes ❑Sorbent Tubes ❑Other <br /> Section 4:Containers/Labels/Samples YES NO N/A <br /> 1)Were custody papers present,filled properly,and legible? <br /> 2)Is the sampler's name present on the CoC? t <br /> 3)Were containers received in good condition(unbroken/unopened/uncompromised)? <br /> 4)Were the samples bagged?(required for microbiology samples;recommended for soil samples) <br /> 5)Were all of,and only,the correct samples received? r / <br /> 6)Are sample labels present,legible,and in agreement with the CoC? <br /> 7)Does the container count match the CoC? l <br /> 8)Was sufficient sample volume/mass received for the analyses requested? <br /> 9)Were samples received in proper containers for the analyses requested? <br /> 10)Were samples received with>1/2 holding time remaining? -/ <br /> 11)Are samples properly preserved as indicated by CoC/labels? <br /> 12)Unpreserved VOAs received-If necessary,was the hold time changed in LIMS? <br /> 13)Are VOA vials free from headspace/bubbles>6mm? / <br /> Section 5:Explanations/Comments <br /> (if no cwnments are made,then no discrepancies rated.) <br /> ❑ No additional ciberepancles <br /> Date Loggedriot y(p ) n7A (sign) A' <br /> B - <br /> Date Labeled By(print) (sign) <br /> Enthalpy Analtical 1-0006.Rev 2:form version 16.3020625 <br /> 5of8 <br />