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Rev.02 Date 07/19 <br /> Receiving Form 001 <br /> SAMPLE RECEIVING REVIEW SHEET <br /> Batch/work Order#: <br /> Client Name:" T Project: <br /> Delivered by: " " ❑ Client ❑ SunStar Courier WGLS ❑ FedEx ❑UPS <br /> If Courier,Received by: Date/Time Courier <br /> Received: <br /> Lab Received by: Date/Time Lab <br /> _OcaV4, Received: <br /> Total number of coolers received: ` Thermometer ID: SC-GUN Calibration due :8/17/21 <br /> Temperature: Cooler#1 (l I °C+/-the CF( °C) = 1 °C corrected temperature <br /> Temperature:. "Cooler"#2 I °C+/-the CF( °C) = I °C corrected temperature <br /> Temperature: Cooler#3 °C+/-the CF( °C) _ °C corrected temperature <br /> Temperature criteria=<_VC Within criteria? ,ryes ❑No ❑N✓A <br /> no 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 ❑No 4 <br /> collected? ❑Yes Acceptable Complete Non-Conformance Sheet <br /> Custody seals intact on cooler/sample RrYes ❑No* ❑N/A <br /> Sample.containers intact NYes ❑No* <br /> Sample labels match Chain of Custody IDs kYes ❑No* <br /> Total number of containers received match COC KrYes ❑No* <br /> -Proper containers received for analyses requested on COC F9Yes ❑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: 6•�(, 2 <br /> Comments: <br /> Page 1 of <br />