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8rqon Laboratories Sample Receipt Checklist <br /> Client• Name �� AIJAL, �r g'+r Date&Time Received o5 17-:7 1 d 3 f V v5 <br /> Protect Name �KXWL-cS {Nninr-a-1 LA+J6 Client Project Number <br /> Received By —701 Matrix Water So,l / <br /> Sample Carrier ' <br /> lent Laboratory 1 FedEx I UPS ! <br /> Argon Labs Protect Number ACUS 3 <br /> Shipping Container 1 Cooler in good condition? Samples received in proper containers? Yes-t No <br /> NIA L--Yes— No Samples received intact? Yes ✓No <br /> Samples received under refngerabon? Sufficient sample volume for requested tests? <br /> Yes No Yes ✓No <br /> Cham of Custody Present? Yes No Samples received wEthin holding time? Yes ✓ No <br /> Chain of Custody signed by all parties? Do samples contain proper preservative? <br /> Yes V/' No NIA Yes �No <br /> Chain of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes No (None submitted____}Yes-1ZNo <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 /> I <br /> Action Taken <br /> OTHER <br /> Date Client Contacted Person Contacted <br /> Comments <br />