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TEST AMERICASAMPLERECEIPT LOG <br /> CLIENT NAME: tiR�S CSG <br /> DATE REC'DATLAB: -q Zr / For Regulatory Purposes? <br /> REC. BY(PRINT) TIME REVI>AT L AB: � ot <br /> DRINKING WATER <br /> WORKORDER: L-r-vj-2 DATE LOGGED IN: WASTE WATER <br /> OTHER <br /> CIRCLE THE APPROPRIATE RESPONSE LAB CLIENT ID 'CONTAINER PRESER SAMPLE DATE Temp. REMARKS: <br /> SAMPLE VATIVE pH MATRIX MATRIX SAMPLED WC <br /> DESCRIPTION CONDITION <br /> 1. Custody Seal(s) Present Absent <br /> Int roken* 0 P"2 q L AWVM <br /> 2, Chain-of-Custod resgel Absent* vop- (4), K <br /> 3. Traffic Reports or I L ani z <br /> $ ... Packing List: Present/Abse VuP- 4 <br /> `4, Airbill I Sticker-Present/Absent Absent 0��, L Aiy�CK '2- <br /> Tracking# <br /> 5. Sample ConditioVInt,�&L <br /> 5 _ggkjng*/Broken* <br /> 6. ed 4�e- <br /> Samples label Na* \V RCI <br /> -7. Sample ID's listed on CC e <br /> 8. Does information on COC. d sample <br /> labels agree? �71 No* <br /> 41 <br /> L =_4 <br /> 9. Sample received within <br /> hold time: Qel No* <br /> 10.Adequate sample volume <br /> received No <br /> 11. Proper preservatives used a No* <br /> 12.Trip Blank Temp Blank Received? <br /> (circle which if yes) Yes I No <br /> -V 3.Thermometer Used : JR-1 /Ir-3)l Backup <br /> 14. Cooler RT*** CF** CT` <br /> 1C, <br /> 2 <br /> 3 <br /> 4 <br /> 15. Is/Are corrected temp 0-8°C? Yes/-No* <br /> **Exception (if any): Metals I Perchlorate <br /> e <br /> W/in 24hrs of sampling-on ice Problem C( <br /> *IF CIRCLED,CONTACT PROJECT MANAGERAND ATTACH RECORD OF RESOLUTION <br /> "CHECK SAMPLE PREP LOG IF NOT INDICATED <br /> SAMPLER ECEIPTLOG <br /> Read Temperature/Correction Factor/Corrected TeMperature <br /> Revision 12(08107108) <br /> Page of <br />