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� Columbia Analytical Services, Inc xaso oa <br />' Phoenix, AZ <br /> Sample Receipt and Preservation Form <br />' Client Project Name C`' <br /> McOH Extracts <br />' Sample(s)Received on 3-/60S date CF/S time <br /> VOA'V Glass Bottles❑ Plastic Bottles❑ Jars❑ Sleeves❑ Tedlar Bags ❑ Encores❑ <br />' MATRIX SOIL❑ WATERY VAPOR❑ <br /> First Extraction Holding Time Expiration date time(soils only) <br /> Is firstextraction/analysis holding time expiration LESS THAN 24 HOURS(soil)/7 DAYS (water)? Yes❑ No❑ <br /> If YES,chemist notified on date time Chemist's Initials <br /> 1 Rush or standard turn-a-round time? RUSH ANDARD <br /> 2 Are the custody seals present? Yes❑ NOD <br /> If yes,how many and where <br /> I • 3 Are the signature and date correct? Yesrf NOD <br /> 4 Did all contamers arrive in good condition? Ye&9 NOD <br /> 5 Are all container labels complete(i a preservation, sample ID)? YqsE1r NOD <br /> 6 Were the correct containers used for the tests mdicated? Yes.4T No❑ <br /> 7 Have VOA's been checked for the presence of air bubbles? (note problems in comments) Ye� NOD NIA❑ <br /> 8 Is there sufficient sample volume to perform We requested analysis Ye NOD <br /> 9 Temperature of sample(s)upon receipt S i 3C� <br /> Explamation of discrepancies <br /> I <br /> VOA Vial pH Verification <br /> (Tested After Analysis) <br /> YES NO ❑All Samples pHs 2 <br /> pH Reagent >2 <br /> 12 1�aOH <br /> 2 HNO, <br /> 2 Hlso4 <br /> 2 HC] <br /> Comments p'n c a C <br /> I <br /> Form Completed and Sample(s) Received by(initials) ✓1� <br /> r\comman\formslsainprecv doc 1 <br /> '14 Revised 12/30/2004 12 27 PM <br />