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McCam bell Anal\/tical Inc. I".%k;llowPass Road.Pittsburg.CA 94565-1701 <br /> k,ll <br /> J i hc, Mcphone (877)252-9262;Fax (925)252-9269 <br /> "When Qualift,CountO higr ww w nxcamphcll.cont/E-mail:main'h'mccampbell coni <br /> Sample Receipt Checklist <br /> Client Name Fremouw Environmental Services,Inc. Date and Time Received 11/1112016 14:18 <br /> Project Name 067753:Herzog Track Date Logged: 1111112016 <br /> Received by Agustina Venegas <br /> WorkOrder Ns 1611556 Matrix 5Qil Logged by Agustina Venegas <br /> Carrier David Shaver(MAI Courier) <br /> Chain of Custody(COC)Information <br /> Chain of custody present? Yes ✓ No LJ <br /> Chain of custody signed when relinquished and received? Yes ✓ No❑ <br /> Chain of custody agrees with sample labels? Yes ['III No❑ <br /> Sample IDs noted by Client on COC? Yes 171,11 No❑ <br /> Date and Time of collection noted by Client on COC? Yes No❑ <br /> Sampler's name noted on COC? Yes No❑ <br /> Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes a No❑ NA❑ <br /> Shipping container/cooler in good condition? Yes No❑ <br /> Samples in proper containers/bottles? Yes No❑ <br /> Sample containers intact? Yes ✓ No❑ <br /> Sufficient sample volume for indicated test? Yes ✓ No <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes 1 No NA❑ <br /> Sample/Temp Blank temperature Temp: 3VC NA❑ <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ NA Ci <br /> Sample labels checked for correct preservation? Yes [ ] No❑ <br /> pH acceptable upon receipt(Metal <2 522 <4:218.7,>8)? Yes I ' No❑ NA O <br /> Samples Received on Ice? Yes V No❑ <br /> (Ice Type WET ICE ) <br /> JCMR3 Samples <br /> Total Chlorine tested and acceptable upon receipt for EPA 522? Yes ❑ NO❑ NA WW1 <br /> Free Chlorine tested and acceptable upon receipt for EPA 218 7 Yes ❑ No❑ NA <br /> 300.1,537,539? <br /> Comments: <br /> Page 9 of 9 <br />