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unS <br /> Laboratories, Inc. rye l of <br /> va°nmxa QUum Axn�mui5envxas N�noxxivu . <br /> SAMPLE RECEIVING REVIEW SHEET <br /> BATCH# TINo-� <br /> Client Name: 9or+,%er CST ' SF Project: 2ttoo't S. S-6ck-k+nroA <br /> pp ikszob <br /> Received by: UfiAn Date/Time Received: tt(LfiIN S'Sa <br /> Delivered by: ❑Client ❑ SunStarCourier KGSO ❑FedEx ❑Other <br /> Total number of coolers received k Temp criteria=6°C>0'C(no frozen containers) <br /> Temperature: cooler#1 F-'( °C+/-the CF (-0.2°C) = S Z °C corrected temperature <br /> cooler#2 'C +/-the CF (-0.2'Cj = 'C corrected temperature <br /> cooler#3 'C+/-the CF (-0.2'C) _ 'C corrected temperature <br /> Samples outside temp.but received on ice,w/in 6 hours of final sampling. KYes ❑No* ❑N/A <br /> Custody Seals intact on Cooler/Sample Yes [-]No" ❑N/A <br /> Sample Containers Intact NYes ❑No* <br /> Sample labels match COC ID's [' Yes ❑No* <br /> Total number of containers received match COC KYes ❑No* <br /> Proper containers received for analyses requested on COC Yes ❑NO* <br /> Proper preservative indicated on COC/containers for analyses requested ❑Yes ❑No* J N/A <br /> Complete shipment received in good condition with correct temperatures,containers,labels,volumes <br /> preservatives and within method specified holding times. KYes ❑No* <br /> *Complete Non-Conformance Receiving Sheet if checked Cooler/Sample Review-Initials and date tv1' 1 102-r6q <br /> Comments: <br />