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Sample Integrity Pg. of CLI GeoOcon 1985 03/31/2009 <br /> II 331018 TAT: Standard ' <br /> Date Received S13t l(�'f <br /> Section 1 Sampled Same Day ' <br /> mple ort: Walk In SNC BSK-Cornier Tra ed In: Ice C st Box Hand <br /> Has chill' rocess be un? Y N Sam les Received: Chilled to Touch / Ambien / On Ice ' <br /> Section 2-Sampled Previousl <br /> Sample Transport: UPS SNC Walk-In BSK-Courier GSO Fed Exp. Other: <br /> No. Coolers/Ice Chests: Temperature(s): 3 , <br /> Was Temperature In Rang Y N Received On Ice: Wet Blue ' <br /> Describe type of packing materials: q u e r Foal Pack Peanuts Pape Ox <br /> Were ice chest custody seals resent? Y Intact: Y , <br /> Section 3-COC Info. Completed Info From Completed Info From <br /> Yes No Container Yes No Container ' <br /> Was COC Received Analysis Requested �r <br /> Date Sam led �. Any hold times less than 72hr <br /> Time Sampled c — Client Name ' <br /> Sample ID Address <br /> Special Storage/Handling Storage/HandlingIns. 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? <br /> Were bottle custody seals intact? ' <br /> Did all bottle labels agree with COC?: <br /> Were correct containers used for the tests re uested?: <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) ' <br /> Were Ascorbic Acid Bottles received with the VOAs <br /> Section 5-Comments/Discrepancies <br /> Sample(s) Split/Preserve'. Yes t No I Container: Preservation: Init.: ' <br /> Was Client Service Rep. notified of discrepancies: Yes No /A CSR: Notified By: ' <br /> Explanations/Comments <br /> 1 <br /> Re ort Comment Entered: ' <br /> c"� <br /> SR-FL-0002-02 Labeled by:_ _ Labels checked by:- <br /> 10'3S— <br /> y:1U'3$— �k;qb , <br />