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ACCESSION : S INITIALS: <br /> AT'I Sanlhego :�� • . <br /> SA�IIPLE CONDI 'ION UPON"R C:EPT',CH.�GELIST' <br /> (FOR RE-ACCESSIONS; C0h71'LETE n7 Tx1ZZT 9} <br /> 1 Does this project require special handling according to N.—,-SC Levels C, D, YES <br /> AFC'-!-E or CLP protocols? <br /> I€ yes, complete a)and b) <br /> a) pH sample aliquoted: yes /no /na <br /> b) Either 1) Record Hoctle Lot Ps: <br /> Or 2) Attach Sample Kit Request Form(s) �] <br /> 2 Number of Coolers Received `�-- <br /> If more than one cooler received attach Multiple Cooler Documentation Form <br /> (MCD) <br /> Indicate "see MCD"on Item 11 below <br /> 3 Are custody seals required for this project ? <br /> YES <br /> a) are Custody Seals present on Cocler(s) ? <br /> YES 0 <br /> If yes, are seals intact ? <br /> YES NO <br /> b) are Custody Seals present on the sample ? <br /> YES 60) <br /> If yes, are seals intact ? <br /> YES NO <br /> 4 Is there a Chain-Of-Custody (COC)' per cooler ? YES NO <br /> if not, if a problem is- found indicate which samples/test were in the <br /> affected cooler on the MCD. <br /> 5 Is the COC' complet per cooler ? NO ` <br /> Relinquished: 6Vno Requested analysis: a /no <br /> 6 Is the COC' � agreement with the sa ples received? NO <br /> f Samples: 6/no Sample ID's: no Date sampled: G�/no <br /> matrix: es no # containers: no <br /> 7 Are the samples preserved correctly? NO <br /> 8 Is there enough sample for all the requested analyses? NO . <br /> 9 Are all samples within holding times for the requested analyses? NO <br /> 10 Record cooler temperature. Contact PM if temperature is not 4°C t 2°C. � 'C <br /> Is ice present in cooler? NO <br /> 11 Were all sample containers received intact (ie. not broken, leaking, S NO <br /> etc.)? <br /> 72 <br /> 12 Are samples requiring no headspace, headspace free? N/A NO <br /> 13 Are VOA 1st stickers required? YES NO <br /> 14 Are there special comments on the Chain of Custody which require client YES /A <br /> contact? <br /> 15 If yes, was ATI Project Manager notified? E_5S NO <br /> Describe "no" items: <br /> Was client contacted? yes / no <br /> If yes, Date: Name of Person contacted: <br /> Describe actions taken or client instructions: <br /> S I <br /> -or ocher representative documents, letters, and/or shipping memos <br />