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CHROMALAB, INC. J <br /> SAMPLE RECEIPT CHECKLIST ! <br /> Client Name Date/Time Received <br /> Date / Time <br /> Project_pg 'R' Tra,ey Received b <br /> Reference/Subm # a51�I� / 329 Carrier name pp � <br /> Checklist Complet S Logged in by Cf— I- /�r <br /> by: - - E� � tt Initials / Date <br /> Signatur / Date Matrix U� <br /> Shipping container in good condition? NA Yes No <br /> Custody seals present on shipping container? Intact—L/ Broken Yes ✓ NO— <br /> Custody <br /> Custody seals on sample bottles? Intact Broken Yes No ✓ <br /> Chain of custody present? Yes--)./— No <br /> Chain of custody signed when relinquished and received? Yes No <br /> Chain of custody agrees with sample labels? Yes ✓ No <br /> Samples in proper container/bottle? Yesj,/ No , <br /> Samples intact? Yes_J No <br /> Sufficient sample volume for indicated test? Yes �/ No <br /> VOA vials have zero headspace? NA Yeses No <br /> Trip Blank received? NA Yes ✓ No <br /> All samples recei.ved wi.t-hin holding time? Yes Y NO <br /> — <br /> Container <br /> Container temprt 1t�.ure?_r O. , G <br /> pH upon receipt off adjusted Check performed by: NA <br /> Any NO response must be detailed in the comments section below. =f items are not <br /> applicable, they should be marked NA. <br /> Client contacted? Date contacted? <br /> Person contacted? Contacted by? <br /> Regarding? <br /> Comments: <br /> Corrective Action: <br /> SMPLRECD.CK <br />