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Alpha Analytical, Inc. <br /> Phone (775)355-1044 FAX (775)355-0406 <br /> Sample Receipt Checklist <br /> Date Report is due to Client 1 011 3120 04 Date of Notice 101512004 9 38 03 A <br /> Please take note of any NO check marks If we receive no response concerning these items within 24 hours of the date of this notice,all of <br /> the samples will be analyzed as requested <br /> I <br /> Client Name Stratus Environmental Project ID USA 65 <br /> I <br /> Pro}ect Manager Gown Kowtha Clients Phone (530) 676-6002 Client s FAX (530) 676-6005 <br /> Work Order Number STR04100560 Date Received 101512004 Received by Stacy Mane Strock <br /> Cham of Gustodv(COG Information <br /> Carrier name FedEx <br /> Chain of custody present? Yes 0 ❑ No <br /> Custody seals intact on shippping container/cooler? Yes 0 ❑ No Not Present ❑ <br /> Custody seals intact on sample bottles ? Yes ❑ ❑ No Not Present <br /> Chain of custody signed when relinquished and received Yes ❑V ❑ No <br /> Chain of custody agrees with sample labels? Yes ❑ No <br /> Sample 10 noted by Client on COC? Yes ❑ No <br /> Date and time of collection noted by Client on COC o Yes ❑ No <br /> Samplers s name noted on COC? Yes ❑ No <br /> 0ternal Chain of Custody(COC)requested 7 Yes No <br /> Sub Contract Lab Used None ElSEM Other(see comments) El <br /> Sample Recei t Information <br /> Shipping containerlcooler in good condition? Yes ❑ ❑ No Not Present ❑ <br /> Samples in proper containerlbottle? Yes ❑ No <br /> Sampie containers intact? Yes ❑V/ ❑ No <br /> Sufficient sample volume for indicated test? Yes d❑ ❑ No <br /> Sample Preservation and Hold Time(HT)]nformation <br /> All samples received within holding time? <br /> Yes ❑ No Cooler Temperature <br /> � 4°C <br /> Container/Temp Blank temperature in compliance(0-6°C)? Yes ❑ No <br /> Water-VOA vials have zero headspace 1 no bubbles? Yes ❑ No No VOA vials submitted ❑ <br /> Sample labels checked for correct preservation? <br /> Yes No <br /> TOC Water-pH acceptable upon receipt(H2SO4 pHe2)? Yes ❑ ❑ No NIA <br /> _Analytical Requirement Information <br /> Are non-Standard or Modified methods requested 7 Yes ❑ 0 No <br /> Are there client specific Project requirements? <br /> Yes ❑ No If YES see the Cham of Custody(COG) <br /> Comments <br />