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McCampbell Analytical, Inc. 1534 Willow Pass Road,Pittsburg,CA 94 56 5-1701 <br /> Web:www.mccampbea.com E-mail:main®mccsmpbell.com <br /> . "When Quality Count,' Telephone:877-252-9262 Fax 925-252-9269 <br /> Sample Receipt Checklist <br /> Client Name: Genesis Engineering & Redevelopment Date and Time Received: 10114/08 8:21:49 PM <br /> Project Name: #115; Coldani, 13436 N. Thornton Rd Checklist Completed and reviewed by: Ana Venegas <br /> WorkOrder N°: 0810330 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 No ❑ <br /> Sample IDs noted by Client on COC? Yes ® No ❑ <br /> Date and Time of collection noted by Client on COC? Yes © No ❑ <br /> Sampler's name noted on COC? Yes © 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 0 No ❑ <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes 0 No ❑ <br /> Container/Temp Blank temperature Cooler Temp: 5.2°C NA ❑ <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ No VOA vials submitted <br /> Sample labels checked for correct preservation? Yes Q No❑ <br /> TTLC Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA <br /> Samples Received on Ice? Yes © No❑ <br /> (IceType: WErICE ) <br /> •NOTE:ff the"No"box is checked,see comments below. <br /> --------------------------------------------- <br /> --------------------------------------------- <br /> Client contacted: Dale contacted: Contacted by: <br /> Comments: <br />