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16 i <br /> Intertek Testing Services <br /> ' = Environmental Laboratories <br /> ' Workorder Client Quote <br /> Number: _ Project ID: '�,��}fp to D Number: <br /> Cooler <br /> Shipping documentation present? 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)- -�j c,3 <br /> Note If all samples taken within previous 4 hr,circle N/A and place in sample storage area as IR TMP Frw <br /> soon as possible $lin` <br />' Samples <br /> Chain of custody seal present for each container? YES NO <br /> Condition Intact Broken <br />' Samples arrived within holding tunes NO N/A <br /> Samples in proper containers for methods requested? CYEV NO <br /> Condition of containers. nfa Broken <br /> If NO, were samples transferred to proper contamer(s)9 Yes No <br /> VOA containers received with zero headspace NO N/A <br />' or bubbles<6 mm? <br /> Container labels complete9(ID, date, time,preservative) NO N/A <br /> Samples properly preserved NO N/A <br />' If NO,was the preservative added at tune of receipt? Yes No <br /> pH check of samples required at tune of receipt9(volatiles checked at analysis) NO <br /> If YES,pH checked and recorded by �,N <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 />' Trip blanks received with sample batch? NO NIA <br /> Chain of Custody <br />' Chain of custody form received with samples NO <br /> Has it been filled out completely and in unk? M. NO <br /> Sample IDs on chain of custody form agree with labels NO <br />' Number of containers on chain agree with number received? NO <br /> Analysis methods specified? NO <br /> Sampling date and time indicated? NO <br /> Proper signatures of sampler,couner and custodian m appropriate spaces? YE NO <br /> With time and datesCYTS No <br /> Turnaround time`s tan Rush <br /> Any NO responses and/or any BROKEN that was checked must be detailed in a Corrective Action Form <br /> Sample Custodian- `sP Date' c-V7 Project Manager Date dj Z 11 <br /> f uofiTtSVw=2 doe <br />