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ACCESSION #: �b� SJZ INITIALS: <br /> ., ..--..-.-.uu :: v.:�::-.:.r.:.�:.-.-..:-':.v{i:i}:::-;}i:iri- - -:"J%y.+\si':\'':' }:{`}.i'J%'\x•` -':""S .�7r.iJ::v:i- %:4i: _.F:. _ - <br /> a:ii'.u.i. ...::::::.... 1. ......... v:-.....:..:. r....Yr.....:.r.... n '.. <br /> .... ..... ............ ...-. On. .Q.... �... .:n ..- r .::[:':v::s G:...:.�:ux•. u1:'ti ik.x <br /> Dtega. <br /> . ;Sari �x{h �: <br /> ;: f:xx <br /> F <br /> AMPLECONDITION UPON RECEIPT C�ECgLIST, <br /> 4 .� {[ <br /> -.. � Doers this project require special handling according to NFESC Levels C, D, YTS NO <br /> AFGEE or CLP protocols? <br /> if yes, complete a)and b) <br /> a) pH sample aliquoted: yes /no /na <br /> b) Either 11 Record Bottle Lot #'s: <br /> or 2) Attach Sample Kit Request Forms) <br /> 2 Number of Coolers Received 1 <br /> mentation Form <br /> If more than one cooler received attach Multiple Cooler Docu <br /> (MGD) <br /> Indicate "see MCD"on Item 11 below <br /> 3 Are custody seals required for this project ? YES N/A <br /> a) are Custody Seals present on Cooler(s) ? <br /> YES NO <br /> If yes, are seals intact ? <br /> Y_S NO <br /> b) are Custody Seals present on the sample ? <br /> NO <br /> If yes, are seals intact ? <br /> r r S NO <br /> 4 Is these a Chain-Of-Custody 'CCC)' per cooler ? NO <br /> if not, if a problem is fcund- indicate which samples/test were in the <br /> affected cooler on the MCD. <br /> 5 Is the CCC' comp per c=;:a= ? NO <br /> Relinwuis::ed: YeL/no -- -_s_ed ar-a'_ysis. ye no <br /> 6 Is theCOC�greement '+:_" _^a rm <br /> san received? --- NO <br /> # samples no Sar :_ ::,3ye Date sarpled: yes no <br /> FatrixAy0/no € --= _rs: es no <br /> 7 Are zh-a s_^ples preserve, ==1y? NO <br /> No <br /> 8 Is there enough sample for ;__ ,he r Guested analyses? <br /> - 9 Are all sa=les within ho-=_-= t-mes for the reeuested analyses? - NO <br /> 10 Record coolar temperature. C=:.=act PM if temperature is not 4'C t 2°C. 7E?.D oC <br /> Is ice present in Goole=? -- NO <br /> 11 Were all samplecor.=aine.s ._==;:ed '-tact (ie. net brc::=n, leaking, No <br /> etc.) ? <br /> 12 Are samples reouirinq no k}_,s=ace, headsoace free? N/A -- NO <br /> 13 P-re 'IcA is,: stickers <br /> 14 Ave there special comments L^2 Chain of Custody which require client <br /> contact? <br /> 15 If ves, was ATI ? ojec- ncti_led? <br /> Describe "no" itar..s: 6 "� 4 <br /> ►r/fS <br /> S-�z �c •• C-c) G . <, �•o.:f2 <br /> Was client ccntacted? yes rc <br /> _f 'I?-=. Dat _ Nama- __ __•- contactad: <br /> De- c_-5e ac -_ns =a..-2n or .c_-er= --'.-.Z <br /> or other representative documents, le==ers, avid/or shiopinq me:==s <br /> A-i 02(03/35) <br />