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' �✓ CHROMALAB, INC`.. <br /> SAIMPLE RECEIPT CHECKLIST <br /> • Client Name l— Date/Time Receive / ;/Cly <br /> Date / Time <br /> 17 <br /> Project -C1949 Received by <br /> Reference/Subm #0✓ Carrier name <br /> Check co le �/� /:Q/ Logged in by l <br /> by: /// /// LSP 1s / Date <br /> Signature / Date Matrix <br /> Shipping container in good condition? NA Yes No <br /> Custody seals present on shipping container? Intact Broken Yes No <br /> Custody seals on sample bottles? Intact Broken Yes No <br /> Chain of custody present? YesNo <br /> Chain of custody signed when relinquished and received? Yes :—// <br /> No <br /> Chain of custody agrees with sample labels? Yes L/No <br /> Samples in proper container/bottle? Yes–:7 No <br /> Samples intact? Yes -ZIo <br /> Sufficient sample volume for indicated test? Yes .r No <br /> VOA vials have zero headspace? NA Yes ✓ No <br /> Trip Blank received? NA Yes No–Z <br /> All samples received within holding time? Yes-Z No <br /> Container temperature?__ / . 6 <br /> PH upon receipt PH adjusted --- Check performed by: NA <br /> Any NO response must be detailed in the comments section below. If items are not <br /> applicable, they should be marked NA. <br /> Client contacted? Date contacted? <br /> Person contacted? Contacted by? <br /> Regarding? <br /> Comments: <br /> Corrective Action: <br /> SNIPLRECD.CK <br />