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1 <br /> X0400 79S <br /> I Columbia Analytical Services, Inc. <br /> Phoenix,AZ <br /> I Sample Receipt-and Preservation Form <br /> I II <br /> Client _A6Project Name <br /> Sample(s)Received on 9 U date Og 3 0 <br /> time <br /> VOA's Glass Bottles Plastic Bottles Jars Sleeves Tedlar Bags <br /> MATRIX SOIL❑ WATER VAPOR❑ <br /> First Extraction Holding Time Expiration date tune(soils only) <br /> Is first extraction/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 /> Il Rush or standard turn-a-round time? RUSH NDARD <br /> 2 Are the custody seals present9 ! t� ` No <br /> If yes,how many and where9T�, y+� �1 a iC�S �d Sit <br /> &) <br /> 3 Are the signature and date correct9 Yes P( No❑ <br /> 4 Did all containers arrive in good condition? Yes No <br /> 5 Are all container labels complete(i a preservation, sample rD)? YesZ No❑ <br />� . 6 Were the correct containers used for the tests indicated? —6) No <br /> 7 Have VOA's been checked for the presence of air bubbles?(note problems in comments) Yes Z No❑ N/A❑ <br /> 8 Is there sufficient sample volume to perform the requ sted analy9 es No <br /> 9 Temperature of sample(s)upon receipt <br /> Explamation of discrepancies <br /> VOA Vial pH Verification <br /> (Tested After Analysis) <br /> I YES NO ❑ All Samples pH S 2 <br /> pH Reagent ❑ Followin Samples Exhibited H>2 <br /> 12 NaOH <br /> 2 HNO3 <br /> 2 H2SO4 <br /> L��2 HCl <br /> Comments <br /> Form Completed and Sample(s) Received by(aunt)als) <br /> r lapmmonlforms\samprecv doc 1 <br /> Revised 8/11/2004 12,44 PM <br />