Laserfiche WebLink
L.. 1,..thcape Testing Services <br /> Environmental Laboratories <br /> SAMPLE RECEIVING CHECKLIST <br /> Workorder Number: �(-/�4�y 3� Client Project ID: <br /> Cooler <br /> Shipping documentation present? YES NO /A <br /> If YES, enter Carrier and Airbill#: <br /> Custody Seal on the outside of cooler? YES NO /A <br /> Condition: Intact Broken <br /> y Temperature of sample(s)within range? )c �i'ES NO N/A <br /> List temperatures of cooler(s): L'` <br /> 4 Note:If all samples taken within previous 4 hr,circle N/A and place in <br /> sample storage area as soon as possible. <br /> Samples <br /> Chain of custody seal present for each container? YES NO <br /> Condition: Intact Broken <br /> Samples arrived within holding time? NO N/A <br /> Samples in proper containers for methods requested? NO <br /> Condition of containers: Intact Broken <br /> If NO,were samples transferred to proper container(s)? <br /> Were VOA containers received with zero headspace? NO N/A <br /> L. If NO,was it noted on the chain of custody? <br /> Were container labels complete? , date,time preservative NO N/A <br /> Were samples properly preserved? gL / NO N/A <br /> L. If NO,was the preservative added at time of receipt? <br /> pH check of samples required at time of receipt? YES QO <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 notified? <br /> Field blanks received with sample batch? YES NO <br /> L. Trip blanks received with sample batch? YE NO N/A <br /> Chain of Custody <br /> Chain of custody form received with les? NO <br /> Has it been filled out completely and in ink? NO <br /> �- <br /> Sample IDs on chain of custody form agree with labels? NO <br /> Number of containers on chain ee with number received? NO <br /> Analysis methods ecified? NO <br /> Sampling date and time indicated? �J NO <br /> Proper signatures of sampler, courier and custodian in YES NO <br /> appropriate s aces?With time and date? <br /> Turnaround time? Standard Rush <br /> Any NO responses and/or any BROKEN that was cfie&ed must be detailed in a Corrective Action <br /> y Sample Custodian: Date:d% 2 2 Project Manager: Date: <br /> F.Tbr son doc �� 006 <br />