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SE1LL�41 BY : CALIF LAB SERVICES ; 7 -27-85 ; 14 ' 14 CALIF LAB SERVICES- 12884648138 ; ti 2 <br /> California Laboratory Services <br /> A � SAMPLE LOG- IN FORM <br /> COC # r—�� Date raceived_C�r C o3d q j ... <br /> Delivered by :. <br /> i <br /> Packaging : cooler = DOT packing other ( specify ) _ <br /> Did package come with shipp8. ng slip? J . . . . . . . . . . . . . • . . . . . • . Yes • • . no <br /> If yes . tracking number <br /> Were custody seals present ? . . . . . . . . > . , A . . _ _ _ . . • • • • • ° ^ ^ ° ° I • » ° • " " ° " ' You ' » <br /> If yes , how many? Date Signed ? . . . ye9 . . . no Intact ? . - - yes . . . no <br /> Custody papers sealed ? . . . . . . . . . . yes . . n�D inside packaging? . . . . . . . • yes . . no <br /> Dil sample containers arrive intact? . . . . . . . . . . . . . . . . . y� • . . no <br /> if no , list any samples broken <br /> Shipping preservation : blue icecoe ice none other__ ^._ <br /> " > ewa-tture upon receipt :' <br /> Geiger co„ nt,pr test . . . . , , . Negativa . . . . . . . . . Pasitirve^^ <br /> Chain of custody filled out properly? . . . . . » . . . . . . . . not present . . . . . . . yes . . a <br /> Did receiver sign chain of custody in correct place ? . . . . » » . • . . • . . » . • . no <br /> Were sample labels complete ? <br /> ( ID , date , time, signature , preservative ) 0 . . 0 . 0 . 0 » 14 . 0 . 0 » » . . . . . . a 0 s . . y Dano <br /> Did sample labels agree witli chain of custody ? . » . . • . . . . . » » . . . . . . . . . . yes . . xRo <br /> Were correct containers used for tests indicated ? . . . . . . . . . . . . . . . . . . ./ ge . • • . nt7 <br /> If no , was pink . slip filled out noting discrepancy? . . . . . . . . . . . . . . . . . ye . . no <br /> Was customer called and notifled? . » . . • . . . _ _ . . . , . a • • • - . - • • • • • • . . N/A . . s . . , no <br /> Were correct preservatives verified? . . . . . . . . . . . . . . . . . . . . . . . . • . . N/A . . . yes . . . na <br /> If year pH of non-volatile samples <br /> Was sufficient amount of sample delivered? . . . . . » . • . . . . . . . » . . . . . . . . . a , yep • • 7no <br /> dere bubbles absent in VOA samples7 . . . . . • • . . . » . . • • • • . • . . . . • . . . N/A • • • Yes . • <br /> Date samples were logged in ' "i4 ,5 By whom S - <br /> Additional comments : _ <br /> T �� - Hemaa / L99i. n - ; rn LAN , / 919a <br /> .: ncrewx+w F1 8i8 a BfiC 0 G a, 9lf 5) 6384530 <br />