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Inchcape Testing Services <br /> Elwb atmentai Laboratories <br /> SAMPLE RECEIVING CHECKLIST <br /> Workorder Client Quote <br /> Number.- Ct k2 I &Ct Pro'eet ID: Gt a Q O Number.- <br /> Cooler <br /> Sluppmg 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 NIA <br /> List temperatures of cooler(s) 3 c, y (, 6 C <br /> Note If all samples taken within previous 4 hr,circle NIA and place iR sample storage area as lR- <br /> soon as possible EWmk <br /> S les <br /> Cham of custody seal present for each container's YES NO 4M�) <br /> Condition Intact❑ Broken❑ <br /> Samples arrived within holdmg times NO N/A <br /> Samples in proper containers for methods requested9 (M NO <br /> Condition of containers Intact CY Broken❑ <br /> If NO were ram les transferred to ro er contain s ? Yes❑ No❑ <br /> VOA containers received with zero headspace NO N/A <br /> or bubbles<6 nun? <br /> Container labels complete? , date, time, preservative) NO N/A <br /> Samples properly preserved9 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?(volatiles checked at analysts) NO <br />' If YES, pH checked and recorded by a I _ <br /> Sufficient amount of sample received for methods requested YE NO <br /> If NO, has the client or PM been notified? Yes❑ No❑ <br />' Field blanks received with sarnple batch? YES NO <br /> Trip blanks received with sample batch YE • NO N/A <br /> Chain of Custody _ <br />' Chain of custody form received with samples? _ NO <br /> Has it been filled out completely and in ink? NO <br /> 1 <br /> Sample IDs on chairs of custody form agree with labels NO <br /> Number of containers on chain agree with number received? NO <br /> Anal is methods ed? _NO <br /> SamphnS date and tune indicated? , NO <br /> Proper signatures of sampler, courser and custodian in appropriate spaces9 YE NO <br /> With time and dates Yes C' No❑ <br /> Turnaround time? Standard p' Rush❑ <br /> Any NO responses and/or any BROKEN that was checked must he detailed in a Corrective Action Form. <br /> Sample Custodian Date i2 l Vf` , Project Manager ^ Date )� <br /> 7 <br />' ffmM4=w3m2doc <br /> I <br />