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-1701 <br /> 15Willow Pass Row,Pittsburg,McCarrl beIi Analytical, Inc. Toll Free Telephone:(877)252-9262/Fax:(925)252-9269 <br /> "When Quality Counts" http://www.mccampbell.com/E-mail:main@mccampbell.com <br /> Sample Receipt Checklist <br /> Client Name: Filter Recycling Date and Time Received: 10/24/2011 5:29:36 PM <br /> Project Name: BNSF Checklist completed and reviewed by: Melissa Valles <br /> WorkOrder N`: 1110709 Matrix: Soil Carrier: Client Drop-In <br /> Chain of Custody(COCl Information <br /> Chain of custody present? Yes W No❑ <br /> Chain of custody signed when relinquished and received? Yes � No❑ <br /> Chain of custody agrees with sample labels? Yes 0 No❑ <br /> Sample IDs noted by Client on COC? Yes No❑ <br /> Date and Time of collection noted by Client on COC? Yes ❑.I 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 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: 5°C NA❑ <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ No VOA vials submitted <br /> Sample labels checked for correct preservation? Yes Q No❑ <br /> Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA <br /> Samples Received on Ice? Yes No❑ <br /> (Ice Type: WET ICE ) <br /> *NOTE:If the "No"box is checked, see comments below. <br /> -------- ------- ------------------------------- <br /> ------ --------- -------------------------- ---- <br /> Client contacted: Date contacted: Contacted by. <br /> Comments. <br />