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FGL Environmental <br /> Revision Date: 2/13/09 Doc TD: F3REC005.005 <br /> Page: 1 of I <br /> Stockton - Condition Upon Receipt (Attach to COC) <br /> Sample Receipt at STK: <br /> I. Number of ice chests/packages received: C 4 j <br /> ?. Were samples received in a chilled condition? Temps:.? <br /> Acceptable is above freezing to 6°C. Also acceptable is reccived on ice(ROO for the same day of sampling or <br /> received at room temperature(RRT)if sampled within one hour of receipt. Client contact for temperature failures <br /> must be documented below. If many packages are received at one time check for tests/H.T.'s/mshesBacli's to <br /> prioritize further review. Please notify Microbiology personnel immediately ofpae+snarples received.. <br /> 3. Do the number of bottles received agree with the COC? ` No N/A <br /> 4. Were samples received intact?(i.e.no broken bottles. leaks etc.) Yes No <br /> 5. VOAs checked for Ileadspace? Yes No <br /> 6. Were sample custody seals intact? Yes No N/A <br /> Sign and date the COC,place in a ziplock and put in the same ice chest as the s les. <br /> Sample Receipt Review completed by(initials): <br /> Sample Receipt at SP: <br /> I. Were samples received in a chilled condition? Temps: <br /> Acceptable is above freezing to 6°C. If many packages are received at one time check for <br /> tests/11-f.'s/rushes/Bacti's to prioritize further review. Please notify Micr of gy personnel <br /> immediately of bacti samples received. <br /> ?. Do the number of bottles received agree with the COC? No N/A <br /> 3. Were samples received intact?(i.e.no broken bottles, leaks etc.) s No <br /> 4. Were sample custody seals intact? <br /> Sign and date the COC.obtain LIMS sample numbers,select methods/icsts and print labels. <br /> Sample Verification, Labeling and Distribution: <br /> I. Were all requested analyses understood and acceptable? Yes No <br /> 2. Did bottle labels correspond with the client's TD's? <br /> es No <br /> 3. Were all bottles requiring sample preservation properly preserved? es No N/A FGL <br /> 4. VOAs checked for lieadspace? <br /> Yes No N/A <br /> 5. Were all analyses within holding times at time of receipt? es No <br /> 6. Have rush or project due dates been checked and accepted? Ye No N//A <br /> Attach labels to the containers and include a copy of the COC for lab delive <br /> Sample Receipt. Login and Verification completed by(initials): <br /> Discrepancy Documentation: <br /> Any items above which are"No"or du not meet specifications(i.e.temps)must be resolved. <br /> 1. Person Contacted:_ <br /> Initiated By: Phone Number: <br /> Problem: Date: <br /> Resolution: (3-15433) <br /> Colki Realtors Inc, <br /> STK0938103 <br /> SRP-09/01/2009-10:42:28 <br /> I <br />