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SAMPLE RECEIPT CHECKLIST Section 1:General Info III!t � Date Received: 2/'iI s- WO# S 2 6 o i 3 Client: 12Nl c cie-u s cr e" c.y I ^I I I Section 2:Shipping/Custody Are custody seals present?❑Yes No Custody seals intact on arrival? P`N/A ❑..__Y..ess 13 No ❑On cooler/box ❑On samples ❑Courier ❑Walk-In ❑Field Sampling lasn!ipping Info: f<o cx Section 3a:Condition/Packaging ❑Outside 0.0.6.0'C(0.0-10.0'C for microbiology)(P M notified) Date Opened 1/'1J'-s- By(initials) ❑ Typeoficeused: 04 et ❑Blue/Gel ❑None ❑Samples received on ice directly from the field;cooling process had begun.(if checked,skip temperatures) ❑Sample matrix doesn't require cooling(e.g.air,bulk PCB).(if checked,skip temperatures) If no cooler:Observed/Adjusted Temp('C): J ThermometerAR Gun: � r/ CF: Cooler Temp('C)t11:2- -7 / 1_V #2:___/_#3:__/_#4: _86:__/_ Section 3b:Microbiology Samples ONo microbiology samples submitted(skip 3b) •Within temp range 0.0-10.0'C or received on ice directly from field. •Adequate headspace for microbiology analysis. Section 3c:Air Samples No air samples submitted(sklp 3c) 01.41-Canisters 061.Canisters ❑Tedlar Bags ❑MCE Cassettes ❑Sorbent Tubes ❑Other Section 4:Containers/Labels/Samples YES NO N/A 1)Were custody papers present,filled properly,and legible? / 2)Is the sampler's name present on the CoC? / 3)Were containers received in good condition(unbroken/unopened/uncompromised)? / 4)Were the samples bagged?(required for microbiology samples•,recommended for soil samples) / 5)Were all of,and only,the correct samples received? / 6)Are sample labels present,legible,and in agreement with the CoV 7)Does the container count match the CoC? i 8)Was sufficient sample volume/mass received for the analyses requested? / 9)Were samples received in proper containers for the analyses requested? i 10)Were samples received with>1/2 holding time remaining? l' 11)Are samples properly preserved as indicated by COC/labels? / 12)Unpreserved VOAs received-If necessary,was the hold time changed in LIMS? / 13)Are VOA vials free from headspace/bubbles>6mm? / Section 5:Explanations/Comments (if no comments are made,then no discrepancies roted.) ❑ No additional discrepancies Date Logged 2�ry/a� By(print) ^14 (sign) Date Labeled--T7` `1 By(print) r`13`^^ (sign) Enthalpy Analytical 1-0006,Rev 2:Form Version 16.3 020625 5of9