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' Inchcape Testing Services <br /> Environmental Laboratories <br /> SAMPLE. RECEIVING CHECKLIST <br /> Workorder Client Quote <br /> Number c�c i k`, i 3 Y Pro ect ID %<<<t Number <br /> Cooler <br />' Shipping documentation presents YES NO / <br /> If YES, enter Carrier and Airbili # <br /> Custody Seal on the outside of cooler) YES NO <br /> Condition Intact E Brokeni--, <br /> Temperature of sample(s) within range9 YES NO NIA <br /> I <br /> List temperatures of cooler(s) z t__ <br /> Note if all samples taken within previous 4 hr,circle NIA and place in sample storage area as <br /> soon as possible <br /> samples <br /> Chain of custody seal present for each container" YES NO ' <br /> Coltdrtrolt Intact L7-" Broken D <br /> Samples arrived within holding time's YE NO N/A <br /> Samples in proper containers for methods requested? Y NO <br /> Condition of containers Intact Broken <br />' If NO, were samples transferred to proper container(s)" Yes C No G <br /> Were VOA containers received with zero headspace) YES NO /� <br /> If NO, were bubbres < 6 mm9 Yes u No = <br /> Were container labels corn lete9 ID, date, time, 2resen ative YES NO N/A <br /> Were samples properly preserved" YES NO <br /> If NO, was the preservame added at time of receipt" Yes ,: No <br /> pH check of samples required at time of receipt" YES (NJ <br /> If YES, pH checked and recorded b <br /> Sufficient amount of sample received for methods requested' YES NC <br />' If NO, has the client or PNI been notified" Yes No <br /> Field blanks received with sample batch" YES NO <br /> Trip blanks received with sample batch? YES NO CFTAA- <br /> Chain of Custod <br /> Chain of custody form received with samples" NO <br /> Has it been filled out completely and in mk? NO <br /> Sample IDs on chain of custodyformagree with labels" NO <br /> Number of containers on chain avree with number recen ed`' NO <br /> Analysis methods spec ified`' NO <br /> Sam lin date and time indicated? NO <br /> Proper signatures of sampler, couner and custodian in appropriate spaces'' ---- NO <br /> 1 With time and date' Yes[i�/ No <br /> Turnaround time) Standard 'Y� Rush <br /> Any NO responses and/or any BROKEN that,"As checked must be detailed in a Correctne Action Form <br /> Sample Custodian If Date r c, 1 ,_ <br /> Pro,ect Manager Date <br /> i tonw;neus�T dok <br />