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LAk <br />ASSOCIATED LABORATORIES <br />806 North Batavia — Orange, California 92868 — 714-771-6900 <br />SAMPLE ACCEPTANCE CHECKLIST <br />FAX 714-538-1209 <br />Section 1` I-� n <br />Client: V e IW b0vj Project: <br />Date Received: Sampler's Nai.n.e:r� No <br />Sample(s) received i coole : es No (Skip Section 2) <br />Ship ink lnfonnation: <br />Section 2 <br />Was the cooler packed with: Ice XIce Packs %Bubble Wrap <br />Paper ��None _ Other <br />Cooler or box temperature: ( ; <br />(Acceptance range is 2 to 6 Deg. C.) <br />— Styrofoam <br />Section 3 YES NO N/A <br />Was a COC received? <br />Is it properly completed? (IDs, sampling date and time, signature,... test) <br />Were custody seals resent? <br />If Yes — were they intact? <br />Were all samples sealed in plastic bags? <br />Did all samples arrive intact? If no, indicate below. <br />Did all bottle labels agree with COC? (ID, dates and times <br />Were correct containers used for the tests required? <br />Was a sufficient amount of sample sent for tests indicated? <br />Was there heads ace in VOA vials? <br />Were the containers labeled with correct preservatives? <br />Was total residual chlorine measured (Fish Bioassay samples only)? <br />*: If the answer is no, please inform rise tsioassay Uupt. L um-,uiaL-, Y. <br />Section 4 <br />Explanations/Comments <br />Section 5 <br />Was Project Manager notified of <br />Y / N N/A <br />Completed By: <br />�' Date: 62 <br />