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TEST AMERICA SAMPLE RECEIPT LOG <br /> CLIENT NAME: DATE RECD AT LAS:. D For Regulatory Purposes7 <br /> PEC.DY{PRINT) AIM TIME RECM AT LAB: • DRINK046 WATER Yt_S <br /> WOMWROER: � d gb t DATE LOQGED IN: �f /tom.�... WASTE WATER <br /> YES t1D <br /> CIRCLE THE APPROPRIATE RESPONSE LAB CUENT M COMARM PRESER SAfIRAi.E DATE REpAq�B: <br /> SAMPLE# DESCRIPTION VATIVE p MAT= SAMMED ' 'CONQRION WC.J <br /> 1. Custody Seai(s) Present! t' <br /> IntactlBrolcen" �;, <br /> 2. t I Abaenr <br /> 3 Tratlic Reports or <br /> -EffLdcs list Present! „ <br /> 4. Alrb . Airbill 1 Slicker 00, <br /> PresentI <br /> 1010 <br /> 6. Alrbiil d: <br /> 8. a labels: ll Absent <br /> 7. Sample IDs: U@b 1 Not Listed <br /> on chwn-oA-cuxtcdy .00 <br /> t3. Sample Corfitlon: IQ#t I Broken'1 <br /> S. 0008Informnuon on chain-of-custody, <br /> tralft reports and sernple I64 <br /> s j^ 7 !Ne <br /> 0. Sample received with <br /> hall time? <br /> 11.Adekluale sample volume <br /> recelved9 1 No- <br /> 1Z. ProW presmveliveg used? 1 lVo• <br /> 131.Trip 81w*1 Ternp Blank Received7 <br /> 9 Yes/ <br /> d. <br /> Asad TwW. d°C <br /> Corrected Temv <br /> Is aorreaked temp 4+1»2'C7 Yes 1 <br /> �few For: <br /> '"E7tcepli�+ <br /> Of aqy: METALS 1 FF CE ' <br /> of 1�rol>lern COC <br /> Raiatar s <br /> 'i1=C1RCl W,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. <br /> • am 7{o7't�CNOG� �a,,,,,�al�, <br />