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Rev. 02 Date 07/19 <br /> Receiving Form 001 <br /> 7itxriPe4r �ecew Iioia �e <br /> SAMPLE RECEIVING REVIEW SHEET <br /> Batch/W.ork Order <br /> Clieni Name: Pro'ect: t� <br /> - erc'acon M*Vk�LI % kkavTe- <br /> Delivered by: ❑ Client ❑ SunStar Courier R GLS " ❑ FedEx ❑UPS <br /> If Courier,Received by: Date/Time CourierReceived: <br /> Date/Time Lab <br /> Lab Received by: �d Received: 6- ?' 2( 7573 <br /> Total number of coolers received: Thermometer ID: SC-GUN Calibration due :8/17/21 <br /> Temperature: Cooler#1 S,U °C+/-the CF( -22C) _ �(•�j °C corrected temperature <br /> Temperature: Cooler#2 °C+/-the CF( °C) = °C corrected temperature <br /> Temperature: Cooler#3 °C+/-the CF( °C) = °C corrected temperature <br /> Temperature criteria=<VC <br /> Within criteria. es [—]No [—]N/Ano frozen containers) <br /> If NO: <br /> Samples received on ice? [—]Yes ❑No <br /> Complete Non-Conformance Sheet <br /> If on ice, samples received same day ❑Yes 4 Acceptable ❑No - <br /> collected? Complete Non-Conformance Sheet <br /> Custody seals intact on cooler/sample Wes [—]No* []N/A <br /> Sample containers intact Yes ❑No* <br /> Sample labels match Chain of Custody IDs KYes ❑No* <br /> Total number of containers received match COC ' Yes ❑No* <br /> Proper containers received for analyses requested on COC <Yes ❑No* <br /> Proper preservative indicated on COC/containers for analyses requested . Yes ❑No* ❑N/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 /> Comments: <br /> Page 1 of <br />