Laserfiche WebLink
TEST AMERICA SAMPLE RECEIPT LOG <br /> CLIENT NAME: v iA,sT6 MANAG" DATE RECD AT LAB: Io%/o s For Regulatory Purposes? <br /> REC. BY(PRINT) L.-M TIME RECD AT LAB: t2,Oc _DRINKING WATER <br /> WORKORDER: M1U0'L-5 DATE LOGGED IN: in/BAR X WASTE WATER <br /> -�e OTHER <br /> CIRCLE THE APPROPRIATE RESPONSE LAB CLIENT ID CONTAINER PRESER PH", SAMPLE DATE Temp. REMARKS: <br /> SAMPLE# DESCRIPTION NATIVE MATRIX SAMPLED >6°C CONDITION <br /> 1. Custody Seal(s) Present/AgRg M9nz-i5-oiA VyASK IZAc IL w W tL� AM130L K7 SQ 71 10 $ a� <br /> Intact/Broken" 8 <br /> 2. Chain-of-Custody se t/Absent* 0 — <br /> 3. Traffic Reports or D 41 <br /> Packing List: Present/ K rocrnl-Pais NNO` <br /> Airbill/Sticker- Present/Ate3 E F 6 V CA 3 <br /> Tracking# n4 J� <br /> 5. Sample Condition- eakin *Broken" 35-01 n WASH eALA4- S 40z. JA V- <br /> 6. <br /> 6. Sam les labeled No* s <br /> 7. Sample ID's listed on COC I No* c <br /> 8. Does information on COC and sample o <br /> labels agree? �Q/No* e <br /> 9. Sample received within F <br /> hold time: )0/No" ti <br /> 10.Adequate sample volume H <br /> received C19/ No" <br /> 11. Proper preservatives used No* ; <br /> 12. Trip Blank/Temp Blank Received? K <br /> (circle which if yes) Yes <br /> .Thermometer Used : IR-1 /AZD/Backupr f <br /> Cooler RT*' CF*"* CT*' N <br /> 1 01-0 —I.0 1-5.a C <br /> 2 <br /> 3 <br /> 4 <br /> 5 lot <br /> 15. Is/Are corrected temp 0-6°C? Yes/O§" <br /> "Exception (if any): Metals/Perchlorate/ <br /> W/in s of sam lin -on ice/Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> **CHECK SAMPLE PREP LOG IF NOT INDICATED <br /> SAMPLERECEIPTLOG **`Read Temperature/Correction Factor/Corrected Temperature <br /> Revision 12(08/07/O8) <br /> Page of <br />