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i <br /> Argon Laboratories Sample Receipt Checklist <br /> Client Name ATC Associates, Inc Date&Time Received 811212004 1510 <br /> Project Name [SSA Gas#110 Client Project Number 54 25912 0003 <br /> Received By P H Matrix Water Fil Sall ❑ <br /> Sample Carrier Client ❑ Laboratory 0 Fed Ex ❑ UPS ❑ Other ❑ <br /> Argon Labs Project Number E08221 <br /> Shipper Container in good condition? Samples recelved in proper containers? Yes [! No ❑ <br /> N/A Yes E] No ❑ Samples received intact? Yes Q No ❑ <br /> Samples received under refrigeration? Yes El No ❑ Sufficient sample volume for requested tests?Yes Q No ❑ <br /> Chain of custody present? Yes 0 No ❑ Samples received within holding time? Yes ❑ No ❑ <br /> Chain of Custody signed by all parties? Yes E] No ❑ Do samples contain proper preservative? <br /> NIA ❑ Yes [} No ❑ <br /> Chain of Custody matches all sample labels? Do VOA vials oontaln zero headspace? <br /> Yes 0 No ❑ (None submitted ❑) Yes No ❑ <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> =--- ----- __ � --�------ <br /> Date Client Contacted �J Person Contacted—S— <br /> Contacted By . LLLJ�ua_ tae.�sd�v[ Subject <br /> Co ments IA U <br /> Action Taken 1tiQ- f0 --�7 " J <br /> ADDITIONAL TEST(S)REQUEST!OTHER <br /> ---—-- --—— _ _-- ---------__�___------ <br /> Contacted By Dale Time <br /> Call Received By <br /> Comments <br /> I <br />