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Q& , <br /> NET Santa Rosa Dwslon LOGIN CHECKLIST <br /> CLIENT- � JOB# LOG# <br /> Project ID <br /> Samples Received On Checked In on 7i,I <br /> 1) Custody Seals ❑ N/A Present ❑ Absent ❑ Broken <br /> 2) Cham of Custody ❑ Present ❑ Absent #(s) <br /> Forms ❑ Complete ❑ Incomplete <br /> 3) Type of packing material used: — <br /> 4) Temperature(s) ' C Thermometer#(s) <br /> 5) Sample Container(s) R( Intact ❑ Broken <br /> 6) Container Label(s) Match COC ❑ Do Not Match <br /> 7) Sample Volume Sufficient ❑ Insufficient <br /> ro 8) Preservative(s) Correct ❑ Incorrect ❑ pH verified ❑ Res Cl chk <br /> (CN & PHI-s) <br /> 9} p Heads ace (VOAs) None 1:1Present (list ID`s 1 number vials affected) <br /> Sample ID # of Vials Sample ID # of Vials <br /> 10) Form Completed By. Date- T <br /> Attach s ' pets packing slip to this form before routing <br /> Problem Resolution. <br /> 1) ❑ Project Coordinator Verbally Informed on <br /> . 2) ❑ Client Informed on By <br /> Project Coordinator Date Resolved. ❑Y ❑ N <br /> Comments- <br /> gartdscvo�nrrm <br />