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Analytical Technologies, Inc. - Fort Collins, Colorado <br /> CONDITION OF SAMPLE UPON RECEIPT <br /> CLIENT kw <br /> SKIPPING CONTAINER ID <br /> 'V �+ <br /> ORKORDER NO. _ Y 7 -r1 r 12 rg_ INITIALS�G✓ DATE <br /> Dass this project require special handling according to NEESA, <br /> Level-3, or CLP protocols? Yes No <br /> 1 If yes, complete a, and b. <br /> a. Cooler Temperature <br /> b. Lot No's. <br /> 2 Are custody seals on cooler intact? N/A Ye No <br /> 3 Are custody seals on sample containers intact? QA Yes No <br /> 4 Is there a Chain-of-Custody (COC) ?" / No <br /> Is the COC' complete? /red No <br /> 5 Relinquished: Yes ---No Requested Analyses: Yes 4,*"_ No i../ <br /> Is the COC' in agreement with the samples received? a No <br /> 6 No. of Samples: Yes •� No Sample ID's: Yes [� 0- <br /> Matrix: yeses No No. of Containers: Yes No <br /> 7 Are the samples preserved correctly? 1 <9RYes No <br /> 8 Is there enough sample for all the requested analyses? 02 No <br /> 9 Are all samples within holding times for the requested analyses: (9e No <br /> 10 Were the samples received cold? Ue Yes No <br /> 1 Were all sample containers received intact? (not broken or es No <br /> leaking, etc.) <br /> 12 Are samples requiring no headspace, headspace free? / Yes No <br /> V13 Do the samples require quarantine? Yes 6 <br /> :.4 Do samples require ATI disposal? No <br /> Describe "No' items (except No's 1, 13 & 14) : <br />' Was client contacted? Yes No <br /> If yes, Date. Name of person contacted: <br /> Describe actions taken or client instructions: <br /> DC'' 93 <br /> Group Leadez-A Signature Date <br /> IOrother representative documents, letters or shipping memos. <br /> r <br /> A'n FRM 201 FC -Revision 21 -02/04/93 <br />