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Inchcape Testing Services <br /> Environmental Laboratories <br /> SAMPLE RECEIVING CHECKLIST <br />' Workorder Client Quote <br /> Number 1(%Q Pro ect ID ZctS 00 Number. <br /> Cooler <br /> Shipping documentation present? YES NO <br /> If YES, enter Carver and Arrbill # <br /> Custody Seal on the outside of cooler? YES NO / <br /> Condition Intact ❑ Broken❑ <br /> Temperature of sample(s)wtthm range? NO N/A <br />' List temperatures of cooler(s) `��Z=��3•� �_�3• <br /> Note If all samples taken withm pre,,rous 4 hr, cucleIl/A and place m sample storage area as <br /> soon as ssible <br />' <br /> Samples <br /> Chain of custody seal present for each container? YES NO N <br /> Condition Intact G Broken❑ <br />' LSamples arrived within holding tune? , NO NIA <br /> Samples in proper containers for methods requested? 'E NO <br /> Condition of containers Intact I0 Broken❑ <br /> If NO, were samples transferred to proper container (s)? Yes❑ No ❑ <br /> Were VOA containers received with zero headspace? NO N/A <br /> If NO, were bubbles< 6 mm? Yes❑ No ❑ <br /> Were container labels complete? (ID, date, time, preservative) YES NO, N/A <br /> Were samples properly presern ed? NO N/A <br /> If NO, was the preservative added at time of receipt? Yes ❑ No <br /> pH check of samples required at time of receipt? Y)~ NO <br /> If YES 2H checked and recorded by `S f <br /> Sufficient amount of sample received for methods requested? NO <br /> If NO, has the client or PM been notified? Yes ❑ No ❑ <br /> Field blanks received with sample batch? YES NO <br />' Tn2 blanks received with sample batch? CYE NO N/A <br /> Chain of Custody <br /> Chain of custody form received with sam les? NO <br /> Has it been filled out completely and in ink? NO <br /> Sample IDs on chain of custody form agree with labels? WNO <br />' Number of containers on chain agree with number received? NO <br /> Analysis methods specified? NO <br /> Samplin,g date and time indicated? NO <br />' Proper signatures of sampler, couner and custodian in appropriate spaces? NO <br /> With time and date" Yes PY No ❑ <br /> Turnaround time? Standard ];-"" Rush ❑ <br />' AnN NO responses and/or am BROKEN that w as checked must be detailed in a Corrects a Action Form <br /> Sample Custodian Date <v I b Project Manager Date 1011.6 <br /> i rorffis%,,.�--,d(x <br /> '; " 23D, <br />