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Intertek Testing Services <br />' = r Environmental Laboratories <br />' Workorder Client Quote <br /> Number: ��-( Project ID: 9 ti , V�] Number: <br /> Cooler <br />' Slipping documentation present? YES NO <br /> If YES, enter Carrier and Airbill#. YES NO <br />' Custody Seal on the outside of cooler? <br /> Condition. Intact Broken NO NIA <br /> Temperature of sample(s)within range? <br /> List temperatures of cooler(s): --�-—14 C- <br /> Note If all samples taken within pre 4 hr,circle NIA and place in sample storage area as IR" t TBlank <br /> CMP <br /> soon as possible <br />' Samples <br /> Chaof custody seal present for each container? YES NO <br /> m <br /> Condition Intact Broken NO NIA <br /> rSamples arrived within holding tune? <br /> Samples in proper containers for methods requested? NO <br /> Condition of containers. Broken <br /> If NO,were samples transferred to proper container(s)? Yes No NO NIA <br /> VOA containers received with zero headspace <br /> ' or bubbles <6 mm9NO NIA <br /> Container labels complete' (ID, date, tune, preservative) NO NIA <br /> Samples properly preserved? <br /> ' If NO,was the preservative added at time of receipt? Yes No NO <br /> pH check of samples required at time of receipt?(volatiles checked at analysis) <br /> If YES,pH checked and recorded by- <br /> Sufficient amount of sample received for methods requested? NO <br /> If NO, has the client or PM been notified9 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 Has it been filled out completely and in inky NO <br /> Sample IDs on chain of custody form agree with labels? NO <br /> Number of containers on chain agree with number received? XF NO <br /> Analysis methods specified? C NO <br /> Sampling date and time indicated? NO <br /> ' Proper signatures of sampler, courier and custodian in appropriate spaces? NO <br /> With time and date? <jj�:, No <br /> ' Turnaround time9 Rush <br /> Any NO responses and/or any BROKEN that was checked must be detailed in a Corrective Action Form. <br /> Sample Custodian "YDate- ���7 Project Manager. Date. ? �L,7 <br /> L/ <br /> 1 <br /> f lfomurnewsQ2 dm - - - - <br />