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Amon Laboratories Sample Receipt Checklist <br /> Client Name ATC Assocates, Inc Date&Time Received 121412003 1650 <br /> Project game Pacific Coast Client Project Number 54 16393 0002 <br /> Received By P H Matrix Water [] Soil ❑ <br /> Sample Carrier Client ❑ Laboratory [2] Fed Ex ❑ UPS ❑ Other ❑ <br /> Argon Labs Prolect Number D12141 <br /> Shipper Comainer in good condition? Samples received in proper containers? Yes No ❑ <br /> NIA Yes No ❑ Samples received intact? Yes ❑ No ❑ <br /> Samples received under refrigeration? Yes No ❑ Sufficient sample volume for requested tests? Yes ❑ No ❑ <br /> Chain of custody present? Yes 0 No ❑ Samples received within Bolding time? Yes ❑ No ❑ <br /> Chain of Custody signed by ati parties? Yes Q No ❑ Do samples contain proper preservative? <br /> NIA ❑ Yes No ❑ <br /> Chain of Custody matches all sample labels? Do VOA vials contain zero heads pace? <br /> Yes ❑ No ❑ (None submitted ❑ ) Yes [] No ❑ <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> • Date Client Contacted _ t 2— A y/.3 Person Conacted rt+v 1/a r (A-i I t.•� <br /> Contacted By K Yct-i Subject <br /> Comments H tlL D CA <br /> Action Taken <br /> ADDITIONAL TEST(S)REQUEST I OTHER <br /> Contacted By Date Time <br /> Call Received By <br /> Comments <br /> • <br />