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FGL Environmental Doc ID: F2REC005.008 <br /> Revision Date: 3/8/01 y <br /> Page: 1 of 1 <br /> Santa Paula - Condition Upon Receipt (Attach to COC) <br /> Sample Receipt: <br /> 1. Number of ice chests/packages received: <br /> Note as OTC if received over the counter unpackaged. <br /> 2. Were samples received in a chilled condition? Temps: <br /> Acceptable is above freezing to 6°C. Also acceptable is received on ice(ROI)for the same day of sampling or <br /> received at room temperature(RRT)if sampled within one hour of receipt. Client contact for temperature failures <br /> must be documented below. If many packages are received at one time check for tests/H.T.'s/rushesBacti's to <br /> prioritize further review. Please notify Microbiology personnel immediately of bacti samples received. <br /> 3. Do the number of bottles received agree with the COC? eI7-s- No N/A <br /> 4. Were samples received intact? (i.e. no broken bottles, leaks etc.) pfn!M> No <br /> 5. Were sample custody seals intact? � Yes No <br /> Sign and date the COC, obtain LIMS sample numbers, select methods/tests and print labels. <br /> Sample Verification, Labeling and Distribution: <br /> 1. Were all requested analyses understood and acceptable? No <br /> 2. Did bottle labels correspond with the client's ID's? of No <br /> 3. Were all bottles requiring sample preservation properly preserved? � No N/A FGL <br /> 4. Were all analyses within holding times at time of receipt? No <br /> 5. Have rush or project due dates been checked and accepted? eZ47A Yes No <br /> Attach labels to the containers and include a copy of the COC for lab delivery. <br /> Sample Receipt, Login and Verification completed by(initials): <br /> Discrepancy Documentation: <br /> Any items above which are"No" or do not meet specifications (i.e. temps)must be resolved. <br /> 1. Person Contacted: Phone Number: <br /> Initiated By: Date: <br /> Problem: <br /> Resolution: <br /> _ 2. Person Contacted: Phone Number: <br /> Initiated By: Date: <br /> Problem: <br /> Resolution: <br /> STK131068- <br /> Ancierson & Associates <br /> RESERVED LABEL FOR 3-9574 <br /> RECEIVED: 03/12/2001 <Label 4 / 4> <br />