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Rev.02 Date 07/19 <br /> Receiving Form 001 <br /> Inc: <br /> ;Faft��Quatm �rr �tyC .l�rPi +�aB <br /> SAMPLE RECEIVING REVIEW SHEET <br /> Batch/Work Order#: <br /> Client Name- T•e r f A C oK Project: 1"l Ou H'� t"lo ut e <br /> Delivered by: ❑ Client ❑ SunStar Courier a-GLS ❑ FedEx ❑ UPS <br /> If Courier,Received by: Date/Time Courier <br /> Received: <br /> Lab Received by: Date/Time Lab <br /> Received: <br /> Total number of coolers received: Thermometer ID: SC-GUN Calibration due :8/17/21 <br /> Temperature: Cooler#1 2_ , 5 °C+/-the CF( —Z°C) = Z,3 °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=<_6°C Within criteria? 'Yes ❑No ❑N/A <br /> no frozen containers <br /> If NO: <br /> Samples received on ice? ❑Yes ❑No 4 <br /> Complete Non-Conformance Sheet <br /> If on ice, samples received same day ❑No 4 <br /> collected? ❑Yes Acceptable Complete Non-Conformance Sheet <br /> Custody seals intact on cooler/sample 25Yes ❑No* ❑N/A <br /> Sample containers intact ]Yes ❑No* <br /> Sample labels match Chain of Custody IDs 9Yes ❑No* <br /> Total number of containers received match COC k1Yes ❑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 L <br />