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LAk <br />ASSOCIATED LABORATORIES <br />806 North Batavia - Orange, California 92868 - 714-771-6900 FAX 714-538-1209 <br />SAMPLE ACCEPTANCE CHECKLIST <br />Section 1 <br />Client: ATS- Project: 6 3 2' <br />Date Received: q _ I r S:unpler'sName Yes No <br />Sample(s) received in cooler: Yes No (Skip Section 2) <br />Shipping Information: <br />Was the cooler packed with: V Ice _ Ice Packs _ Bubble Wrap <br />_ Paperer,,None _ Other <br />Cooler or box temperature: 5- -D <br />(Acceptance range is 2 to 6 Deg. C.) <br />Styrofoam <br />Section 3 YES NO N/A <br />Was a COC received? <br />Is it properly completed? IDs sampling date and time, signature, test <br />Were custody seals resent? <br />If Yes - were they intact? <br />Were all samples sealed in plastic bags? <br />Did all samples arrive intact? If no, indicate below. <br />Did all bottle labels agree with COC? (ID, dates and times <br />Were correct containers used for the tests required? <br />Was a sufficient amount of sample sent for tests indicated? <br />Was there heads ace in VOA vials? <br />Were the containers labeled with corTawl treservatives? <br />Was total residual chlorine measured Fish Bioassay samples only)? "k <br />*: If the answer is no, please inform Fish Bioassay Dept. immediately. <br />Section 4 <br />Explanations/Comments <br />Section 5 <br />Was Project Manager notified of discrepancies: Y / N N/A <br />Completed By: Date:—3 ZS <br />