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® McCampbell Analytical, Inc. : Will.Pass Road,Pi-mail: ain 94565-1701 <br /> Web:www.mccampbelLcom E-mail:mein(ajnccempbell.com <br /> "When Omlinv Counts" Telephone:877-252-9262 Fax:925-252-9269 <br /> • Sample Receipt Checklist <br /> Client Name: Genesis Engineering & Redevelopment Date and Time Received: 10/1612008 3:56:14 PM <br /> Project Name: (1115; Coldani Checklist completed and reviewed by: Kimberly Burks <br /> WorkOrder N°: 0810383 Matrix Water Carrier: Michael Hernandez(MAI Courier) <br /> Chain of Custody(COC)Information <br /> Chain of custody present? Yes © No ❑ <br /> Chain of custody signed when relinquished and received? Yes © No ❑ <br /> Chain of custody agrees with sample labels? Yes J❑ No ❑ <br /> Sample IDs noted by Client on COC? Yes ® No ❑ <br /> Dale and Time of collection noted by Client on COC? Yes © No ❑ <br /> Sampler's name noted on COC? Yes R] No ❑ <br /> Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes ❑ No ❑ NA <br /> Shipping container/cooler in good condition? Yes ® No ❑ <br /> Samples in proper containers/bottles? Yes © No ❑ <br /> Sample containers intact? Yes ® No❑ <br /> Sufficient sample volume for indicated test? Yes © No❑ <br /> Sample Preservation and Hold Time INTI Information <br /> All samples received within holding time? Yes Z No❑ <br /> Container/Temp Blank temperature Cooler Temp: 11.3'C NA ❑ <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ No VOA vials submitted 21 <br /> Sample labels checked for correct preservation? Yes No❑ <br /> TTLC Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA <br /> Samples Received on Ice? Yes © No❑ <br /> (IceType: WET ICE ) <br /> "NOTE:If the"No"box is checked,see comments below. <br /> --------------------------------------------- <br /> Client contacted: Date contacted: Contacted by: <br /> Comments: <br />