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Laboratories Sample Receipt Checklist <br /> Client Name �,j�_��;H f >> Date&Time Received I lrS 0 1 l 10 <br /> Protect Name � ��n - �,}�,c S� Client Protect Number Z s'� <br /> Received By C Z Matrix Water E9-- Sall ❑ Other <br /> Sample Carrier Client 2"--Laboratcry ❑ Fed Ex ❑ UPS ❑ Other ❑ <br /> Argon Labs Protect Number <br /> Shipper Container in good condition? Sufficient sample volume for requested tests? Yes 12- No ❑ <br /> NIA ❑ Yes No ❑ Samples received within holding lime? Yes El— No <br /> Samples rece,ved under refrigeration? Yes No ❑ Do samples contain proper preservative? <br /> NIA ❑ Yes ❑7— Na ❑ <br /> Cham of cuslody present? Yes No ❑ VCA vials with preservative? <br /> NIA ❑ Yes No ❑ <br /> Chan of Custody signed by all parties? Yes No ❑ VOA vials preservative type <br /> NCL LJ-- Na2S207 ❑ Other _ <br /> Cham of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes No ❑ NIA ❑ Yes No ❑ <br /> Samples received in proper containers? Yes ❑ No ❑ Samples received intact? Yes D-- No ❑ <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW— <br /> Date ClEenl Contacted Person Contacted <br /> Contacted By Subject <br /> Comments_ <br /> Action Taken <br /> ADDITIONAL TEST(S)REQUEST I OTHER <br /> Contacted By Date Time <br /> Call Received By <br /> Comments <br /> v502 <br />