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Ar on Laboratories Sample Receipt Checklist <br /> Client Name ATC Associates, Inc tate&Time Received 12/6/2004 1635 <br /> orolect Name Diesel Performance Client Project Number 54 62577 0001 <br /> Received By E P Matrix Water ❑ Sod ❑ <br /> Sampfe Carver Client ❑ Laboratory ❑ Fed Ex ❑ UPS ❑ Other ❑ <br /> ' Arcon tabs Project Number E12111 <br /> Sniope,Container in good condition? Samples received m proper containers? Yes 2 No ❑ <br /> ' N1A Yes ❑ No ❑ Samples received intact? Yes ❑ No ❑ <br /> Samptes received under refrigeration? Yes ❑ No ❑ Sufficient sample volume for requested tests?Yes [] No ❑ <br /> ' Cnain of custooy present? Yes ❑ No ❑ Samples received within holding time? Yes 0 No ❑ <br /> Chain of Custody signed by alt parties? Yes r❑ No ❑ Do Samples contain proper preservative? <br /> NIA ❑ Yes ❑ No ❑ <br /> Crain Of Custody matches all sample labels? Do VOA orals contain zero headspace? <br /> Yes ❑ No ❑ (None submitted <br /> ' ❑ ) Yes ❑ No ❑ <br /> A_ <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> Date Client Contacted Person Contacted <br /> Contacted By Subject <br /> Comments <br /> ' Action Taken <br /> ADDITIONAL TEST{S}REQUEST!OTHER <br /> Contacted By Date <br /> Time <br /> Call Received By <br /> Comments <br /> 1 <br />