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' Inchcape Testing Services <br /> Environmental Laboratories <br />' <br /> pWorkorder Client Quote <br /> Number u� Pro ect ID. Z�4 0,� Number <br /> -7 <br /> Cooler <br />' Shipping documentation present9 YES NO <br /> If YES, enter Carrier and Airbill# <br /> Custody Seal on the outside of cooler9 YES NO / <br /> Condition Intact❑ Broken❑ <br /> Temperature of sample(s)within range? NO N/A <br /> List temperatures of cooler(s) ;t ,< 3,L 2_+ 3, <br /> Note If all samples taken"nthur prm rous 4 hr,ccircle iT A and place in sample storage area as <br /> soon as possible <br /> Samples <br /> Cham of custody seal present for each container9 YES NO N <br /> Condition Intact ❑ Broken❑ <br />' <br /> Samples arrived within,holding tume9 NO NIA <br /> Samples to proper containers for methods requested9 'E NO <br /> Condition of containers Intact J2-- Broken❑ <br /> If NO, were samples transferred to proper container s 9 Yes❑ No ❑ <br /> Were VOA containers received with zero headspace9 NO NIA <br /> If NO, were bubbles< 6 mm`s Yes❑ No ❑ <br /> Were container labels complete? ID, date, time, reservaWye YES N NIA <br /> Were samples properly preserved? NO N/A <br /> If NO, was the preservative added at time of recet t9 Yes ❑ No ❑' <br /> pH check of samples required at time of receipts YI✓ NO <br /> If YES, pH checked and recorded by I e <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 batch9 YES NO <br />' <br /> Trip blanks received with sample batch9 YE NO NIA <br /> Chain of Custody <br /> Chain of custody form received with samples? NO <br /> Has it been filled out completely and in inky NO <br /> Sample IDs on chain of custody forma ee with labels? S-3 NO <br /> Number of containers on chain acree with number recetved9 wS NO <br /> ' Analysis methods specified? NO <br /> Sampling date and time indicated? NO <br /> 1 Proper signatures of sampler, couner and custodian in appropriate spaces9 NO <br /> With time and date? Yes P- No ❑ <br /> Turnaround time9 Standard Q,' Rush <br /> ' Ani NO responses and/or am BROKEN that►gas checked must be detailed in a Correcti%e Action Form <br /> Sample Custodian P Date �(� b Project Manager Date la J6 <br /> 1 lnrrrtsncu5rt dcx � J <br />