Laserfiche WebLink
ACCESSION #: SlfoC� INITIALS: <br /> ATISanDlego <br /> StAfPLE COND�TIDN UPON RE'CE£P7' CHEC, .IS�" <br /> (FOR RE-ACCESSZQNS, <br /> COMPLETE #7 THRU9) .. .. ..:. .. . .::.. .. <br /> } j Does this project require special handling according to NFESC Levels C, D, YES NO <br /> AFCEE or CLP protocols? <br /> If yes, complete a)and b) <br /> a) pH sample aliquoted: yes /no /na <br /> b) Either 1) Record Bottle Lot $'s: <br /> Or 2) Attach Sample Kit Request Form(s) <br /> 2 Number of Coolers Received f <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 N/A <br /> a) are Custody Seals present on Cooler(s) ? <br /> YES NO <br /> If yes, are seals intact ? CoJ D4 <br /> YES NO <br /> b) are Custody Seals present'on the sample ? <br /> YES NO <br /> If yes, are seals intact ? <br /> YE 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 complpYESer cooler ? NO <br /> Relinquished: no Requested analysis: es no <br /> b Is the CDC' ' agreement with Che 33�ples received? YE NO <br /> f Samples: e o Sample ID's: a i/no Date sampled: es no <br /> Matrix: yes no ; containers: es no <br /> 7 Are the samples preserved correctly? Y'ES NO <br /> '= 8 Is there enouah sample for all the requested analyses? S No <br /> YE <br /> 9 Are all samples within holding times for the requested analyses? YE NO <br /> 10 Record cooler temperature. Contact PM if temperature is not 4°C i 2'C. ' <br /> Is ice present in cooler? IG— NO <br /> 11 Were all sample containers received intact (ie. not broken, leaking, YES NO <br /> etc.)? <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? J <br /> 15 If yes, was ATI Project Manager notified? 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 /> -Or other representative documents, letters, and/or shipping memos <br /> ATIFIR-4902(03/95) <br />