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1 <br /> Applied-P & CH Laboratories <br /> 13760 Magnolia Ave, Chino CA 91710 <br /> Tel (909)590 1828 F-ax (909)590-1498 Sample Receiving Checklist <br /> -In <br /> WJW <br /> APCL ServiceID. Client Name/Project: <br /> *T <br />' I Sample Arrival <br /> Date/Time Received vm) Date/Time Opened 010 By (name) <br /> Custody Transfer ❑ Client ❑Golden State RNJPS ❑ US Mail ❑ FedEx ❑APCL Empl <br />' 2 Chain-of-Custody (COC) <br /> iA With Samples? ❑ Faxed? Client has Copy? Signed, dated? By <br /> Wrolect ID? EIPINnalyses Clear? ❑ Hold Samples? #on Hold # Received <br /> CoC/Docs Zip--LLo�cder lid? El Compos # _ Samples OK? <br /> Sampled By <br /> 3 Shipping Container/Cooler <br /> Wooler Used? f -2- Cooled by g)ce ElBlue Ice ElDry Ice 1:1None <br /> Temp *C I _ ,�T <br /> 1 (Cooler temperature measured from temp blank if present, otherwise measured from the cooler) <br /> Cooler Custody Sea€? ❑Absent RrIntact ❑ Tampered? <br />' 4 Sample Preservation <br /> ❑ pH <2 ❑pH >12 <br /> If Not, pH Preserved by ❑ Client ❑ APCL ❑Third Party <br /> 5 Holding-time Requirements — <br /> ❑ pH 24hr 11BACT 6/24hr C3CrV' 24hr ElNO48hr ❑BOD 48hr <br /> ❑ Cl2 ASAP ❑Turbidity 48hr ❑ DO ASAP ❑ Fe(I1) ASAP <br />' ❑ HT Expired? ❑ Client nota ied7 <br /> B. Sample Container Condition <br /> *P Intact? ❑ Broken? ❑Anomalies Documented? <br /> Type ❑ plastic lass M Tube brass/SS ❑Tedlar Bag <br /> Quantity OK? El Leaking? I I Appropriate for specific method? <br />' Caps tight? ❑Air Bubbles? I I Adequate Volume? <br /> Labels Unique ID? Wate/Time ID Label and ink intact? <br /> 7. Turn Around Time <br />' 0 RUSH TAT Std (7-10 days) ❑ Not Marked <br /> 8 Sample Matrix <br />' ❑ Drinking H2OOther Liq gdo ❑Wipe El Polymer El Air ❑Other <br /> 1J_ Ground H2O Sludge Filter ❑Oil/Petro ❑ Paint ❑W Water ❑ Extract ❑ Unknown <br /> 9 Pre-Login Check List Col pleted & OK? <br />' ALL OK? (if not, see SAP C-11) ❑Client Contact? (Name )Date/Time <br /> Received/Checked by Printed 3 Apr 2006 8 41a m <br /> "HT1 Samples must be analyzed for results tofleet total concentrations Results generated outside required of holding times are considered minimal <br /> values and may be used to define waste a hazardous but not as non hazardous <br /> Pocam..LPile meal 1a=f Isahmyrcl te= <br /> 1 <br />