Laserfiche WebLink
TestAmerica Cooler Receipt Form/Narrative Lot Number: c� <br /> North Canton Facility <br /> Client TA_SG,n Fr"n Project Kj,,a _ 2. By: A--e-,4_ _ <br /> Cooler Received on q-;2-T-1 o Opened on 9-20,/ Q (Signature) <br /> FedEx 0 UPS ❑ DHL ❑ FAS ❑ Stetson ❑ Client Drop Off❑ TestAmerica Courier❑ Other <br /> TestAmerica Cooler# Multiple Coolers ❑ Foam Box ❑ Client Cooler EJ—Other <br /> 1. Were custody seals on the outside of the cooler(s)?Yes 2- No ❑ Intact? Yes D No ❑ NA ❑ <br /> If YES, Quantity_ 1 _ Quantity Unsalvageable <br /> Were custody seals on the outside of cooler(s) signed and dated? Yes 4. No ❑ NA ❑ <br /> Were custody seals on the bottle(s)? Yes ❑ No <br /> If YES, are there any exceptions? <br /> 2. Shippers' packing slip attached to the cooler(s)? Yes J�J'—No ❑ <br /> 3. Did custody papers accompany the sample(s)? Yes [].No ❑ Relinquished by client? Yes Flo ❑ <br /> 4. Were the custody papers signed in the appropriate place? Yes a- No ❑ <br /> 5. Packing material used: Bubble Wrap ❑' Foam 9" None ❑ Other <br /> 6. Cooler temperature upon receipt 3-6 °C See back of form for multiple coolers/temps ❑ <br /> METHOD: IR L' Other ❑ <br /> COOLANT: Wet Ice 1Blue Ice ❑ Dry Ice ❑ Water ❑ None ❑ <br /> 7. Did all bottles arrive in good condition (Unbroken)? Yes,Q--No ❑ <br /> 8. Could all bottle labels be reconciled with the COC? Yes No 0 <br /> 9. Were sample(s) at the correct pH upon receipt? Yes ❑ No ❑ NA <br /> 10. Were correct bottle(s) used for the test(s) indicated? Yes a- No ❑ <br /> 11. Were air bubbles>6 mm in any VOA vials? Yes ❑ No ❑ NA-❑" <br /> 12. Sufficient quantity received to perform indicated analyses? Yes Ej No ❑ <br /> 13. Was a trip blank present in the cooler(s)? Yes ❑ No 2[` Were VOAs on the COC? Yes ❑ Na <br /> Contacted PM Date by via Verbal ❑ Voice Mail ❑ Other❑ <br /> Concerning <br /> . . ..... ....... <br /> 94: CHAIN OF CUSTODY <br /> The following discrepancies occurred: <br /> 15 SAMPLE CONDITION <br /> Sample(s) were received after the recommended holding time had expired. <br /> Sample(s) were received in a broken container. <br /> Sam les were received with bubble >6 mm in diameter. (Notify PM) <br /> 96. SAMPLE PRESERVATION <br /> Sample(s) were further preserved in Sample <br /> Receiving to meet recommended pH level(s). Nitric Acrd Lot#051010-HNO3; Sulfuric Acid Lot#051010-H2SO4; Sodium <br /> Hydroxide Lot#100108-NaOH, Hydrochloric Acid Lot#092006-HCI, Sodium Hydroxide and Zinc Acetate Lot#100108- <br /> (CH3C00)2ZN/Na0H. What time was preservative added to sample(s)? <br /> Client ID pH Date Initials <br /> SOP: NC-SC-0005,Sample Receiving <br /> North Canton IPV216R.�fffVET�3i7mencalCooterReceipi7'est.4mericalCOOLER_TesMmenca_Rev78_063010.doc15 <br />