Laserfiche WebLink
SAMPLE RECEIPT CHECKLIST <br />�I <br />Section 1: General Info 1•t <br />Date Received: 2 WO# S> L ?k I Client: ?t'�" `�C-o c,t rices it "" <br />Section 2: Shipping/ Custody Are custody seals present? I--) Yes 2rNo <br />Custody seals intact on arrival? EYN/A ❑ Yes ❑ No ❑ On cooler / box ❑ On samples <br />❑ Courier ❑ Walk -In ❑ Field Sampling Orhipping Info: r` o �K <br />Section 3a: condition / packaging ❑ Outside 0.0 - 6.0'C (0.0 -10.0'C for microbiology) (PM notified) <br />Date Opened t /' 9/iN By (initials) Fi"D Typeof ice used: R'Wet ❑ Blue/Gel p 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 ('C): / Thermometer/IR Gun: / /2 ?/ CF: • / <br />Cooler Temp ('C) #1:3 l / 3-4 #2:__]_ #3:__/_ #4:�_ g5:_J 06:__/_ <br />Section 3b: Microbiology Samples No microbiology samples submitted (skip 3b) <br />Cl Within temp range 0.0-10.0'C or received on ice directly from field. <br />Cl Adequate headspace for microbiology analysis. <br />Section 3c: Air Samples No air samples submitted (skip 3c) <br />01.41. Canisters 06L Canisters ❑Tedlar Bags ❑MCE Cassettes ❑Sorbent Tubes ❑Other <br />Section 4:Containers / Labels /Samples <br />1) Were custody papers present, filled properly, and legible? <br />2) Is the sampler's name present on the CoU <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 />% Were all of, and only, the correct samples received? <br />6) Are sample labels present, legible, and in agreement with the CoV <br />YES <br />NO N/A <br />/ <br />/ <br />/ <br />/ <br />7) Does the container count match the CoC? <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 />i <br />/ <br />/ <br />_ <br />11) Are samples properly preserved as indicated by CoC / labels? <br />/ <br />12) Unpreserved VOAs received - if necessary, was the hold time changed in UMS? <br />13) Are VOA vials free from headspace/bubbles > 6mm? <br />/ <br />/ <br />Section 5: Explanations/ Comments <br />(it no comments are made, then no discrepancies noted.) <br />❑ No additional discrepancies <br />Date Logged 2 /r`flu- By (print) P-I''�"'' (sign) <br />Date Labeled n f-ifxu By (print) (sign) <br />Enthalpy Anah'tlral <br />1.0005, Rev 2: form Version 16.3 020625 <br />5of8 <br />