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' 2009050731 05/12/2009 <br /> Sample Integrity Pg. of CLIE Geo Con TAT: Standard <br /> i 512026 <br /> Date ReceivedSl I7-LGy1 Pr. Illlllllllllllllllillllllllllllllllllllllllllillllllllllllll <br /> ' Section 1-Sampled Same Day <br /> g ,� ple Transport:Walk In SNC BSK-Courier rannsporteh Ice Chest Box Hand <br /> ' Has chilling process begun? Y N Samples Received: Chilled to Touch Ambient / On Ice <br /> Section 2-Sampled Previously <br /> ' Sample Transport: AO UPS SNC Walk-In BSK-Courier GSO Fed Exp. Other: <br /> No. Coolers/Ice Chests: Temperature(s): <br /> Was Temperature In Range :.In N Received On Ice: Wet l'u <br /> Describe type of packing materials: uUb1e Wrap F n Packing Pean _ Paper Othpi. <br /> Were ice chest custody seals resent? Y Intact: Y Ir <br /> ' Section 3-COC Info. Completed Info From Completed Info From <br /> Yes No Container Yes No Container <br /> Was COC Received Analysis Requested <br /> ' Date Sampled Any hold times less than 72hr <br /> Time Sampled Client Name —� <br /> Sample ID Address <br /> Special Storage/Handling Storage/HandlingHis. Telephone# <br /> ' Section 4-Bottles/Analysis Yes No N/A Comment <br /> Did all bottles arrive unbroken and intact?: <br /> ' Were bottle custody seals resent? r— <br /> Were bottle custody seals intact? — <br /> Did all bottle labels agree with COC?: <br /> ' Were correct containers used for the tests requested?: �. <br /> Were correct preservations used for the tests requested?: <br /> Was a sufficient amount of sam le sent for tests indicated?: <br /> ' Were bubbles present in VOA Vials?: Volatile Methods Only) c— <br /> Were Ascorbic Acid Bottles received with the VOAs <br /> ' Section 5-Comments/Discrepancies <br /> Sample(s) Split/Preserve: Yes No I Container: Preservation: Init.:_ <br /> Was Client Service Rep.notified of discrepancies: Yes No /A CSR: Notified By: <br /> Explanations/Comments <br /> ' Report Comment Entered: <br />' SR-FL-0002-02 Labeled by: ( /\ Labels checked by: <br /> - V 11 <br />