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McCamabell Analvticala In C. 1534 Willow Pass Road,Pittsburg,CA 94565-1701 <br /> Web:www.menarnpbetisom E-mail:mvn(a�mccampbell.com <br /> "WhrnOueliN Counts" Tel hone:877-252-9262 Fax:925-252-9269 <br /> Sample Receipt Checklist <br /> Client Name: Safety Kleen Date and Time Received: 9123/081:13:23 PM <br /> Project Name: Sample A; Wast Ink Checklist completed and reviewed by: Melissa Valles <br /> WorkOrder N': 0809678 Matrix Liguid/Solid Carrier: UPS <br /> Chain of Custody(COC)Information <br /> Chain of custody present? Yes ® No❑ <br /> Chain of custody signed when relinquished and received? Yes ® No❑ <br /> Chain of custody agrees with sample labels? Yes No❑ <br /> Sample IDs noted by Client on COC? Yes © No❑ <br /> Dale 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 ❑ 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 0 No❑ <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes © No❑ <br /> Container/Temp Blank temperature Cooler Temp: NA <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ No VOA vials submitted <br /> Sample labels checked for correct preservation? Yes © No❑ <br /> TTLC Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA <br /> Samples Received on Ice? Yes ❑ No <br /> `NOTE:If the"No"box is checked,see comments below. <br /> --------------------------------------------- <br /> --------------------------------------------- <br /> Client contacted: Date contacted: Contacted by: <br /> Comments: <br />