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NET Santa Rosa Division LOGIN CHECKLIST <br /> .CLIENT r0, A JOB# LOG #: nLfqc) <br /> Project ID <br /> Samples Received On Checked in on <br /> 1) Custody Seals ❑ NIA Present ❑ Absent ❑ Broken <br /> 2) Chain of Custody Present ❑ Absent #(s) <br /> Forms Lad Complete ❑ Incomplete <br /> 3) Type of packing material used _„ p <br /> 4) Temperature(s) I ' C Thermometer#(s) <br /> 5) Sample Container(s) IJ Intact ❑ Broken <br /> 6) Container Label(s) 10/ Match COC ❑ Do Not Match <br /> 7) Sample Volume Sufficient ❑ Insufficient <br /> 108) Preservative(s) Correct ❑ Incorrect ❑ pH verified ❑ Res Cl chk <br /> (CN & PHLs) <br /> 9 Heads ace OAs None ❑ Present list ID's I number vials affected <br /> l p N ) ( ) <br /> Sample ID # of Vials Sample ID # of Vials <br /> 10) Form Completed By Date- <br /> Attach A!, pac ing slip to this form before routing <br /> Problem Resolution <br /> 1) ❑ Project Coordinator Verbally Informed on <br /> 2) ❑ Client Informed on By <br /> Project Coordinator- Date Resolved ❑ Y ❑ N <br /> Comments: <br /> gamisc�ognfrm <br />