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Amon Laboratories Sample Receipt Checklist <br /> Client Name ATC Associates, Inc Date&Time Received 111212004 1630 <br /> Protect Narne Diesel performance Client Protect Number 54 62577 0001 <br /> Received By P H Matrix Water [] Soil ❑ <br /> Sample Carner Client ❑ Laboratory Q Fed Ex ❑ UPS ❑ Other ❑ <br /> ' Argon Labs Protect Number E11041 <br /> Shipper Container in good condition? Samples received in proper containers? Yes <br /> ❑ Na <br /> ' <br /> NIA Yes Q No ❑ Samples received intact? Yes ❑ No ❑ <br /> Samples received under refrigeration? Yes No ❑ Sufficient sample volume for requested tests?Yes [] No ❑ <br /> ' Cham of custody present? Yes ❑ No ❑ Samples received within holding time? Yes ❑ No ❑ <br /> Cnam of Custody signed by all parties? Yes [ No ❑ Do samples contain proper preservative? <br /> NIA ❑ Yes El No ❑ <br /> Cham of Custody matches at[sample labels? Do VOA vials contain zero headspace? <br /> Yes ❑ No {None submitted <br /> ❑j Yes 0 No ❑ <br /> ANY"No" RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> Date Client Contacted _.. I 1 �L- 1 o y Person Contacted t }= l arcs — <br /> Contacted By H fa.-� <br /> Subject c,,�-. � �. � D C,or+-G Gf,`� 1 <br /> ' Comments :`'011t �fi o�G a - -Fn e <br /> 1 <br /> ' Action Taken <br /> ADDITIONAL TEST(S)REQUEST 1 OTHER <br /> Contacted By Date Time <br /> ' Call Received By <br /> Comments <br /> 1 <br />