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ACCESSION #:�Id IN1TlALS: x FF: TI011T UPON RECEIPT CHEESSIONS_,-COMPTE #7 TFHRproject require special handling according to NF£SC Levels C, D, YES NO CLP protocols? mplete a)and b}ample aliquoted: yes /no /na r 1) Record Bottle Lot #'s: 2) Attach Sample Kit Request rorm(s) 2 1Number of Coolers Receivedl r - If more than,ons cooler received attach Multiple Cooler Documentation Form l ` (MCD) Indicate "see MCD"on Item 11 below 3 Are custody seals required for this project ? YES N/A a) are Custody Seals present on Cooler(s) 2 YES NO . If yes, are seals intact ? �A YES NO b) are Custody Seals present on the sample ? YES NO If yes, are seals intact ? YES NO A 4 4 Is there a Chain-Of-Custody (COC)' per cooler ? YES NO it not, if a problem is found indicate which samples/test were in the affected cooler on the MCD. 5 Is the COC' comply per cooler 2 YES NO Relinquished: es no Requested analysis: g es no 6 Is the COC' agreement with the les received? YES NO # Samples: y o Sample ID's: e o Date sampled: yes no Matrix: yes no / containers: a /no YES NO 7 Are the samples preserved correctly? 8 Is there enough sample for all the requested analyses? YE NO 9 Are all samples within holding times for the requested analyses? YES NO 10 Record cooler temperature. Contact PM if temperature is not 4°C t 2°C. � . � •�oC Is ice present in cooler? NO 11 Were all sample containers received intact (ie. not broken, leaking, NO etc.)? 12 Are samples requiring no headspace, headspace free? N/A S N 13 Are VOA 1st stickers required? YES 14 Are there special comments on the Chain of Custody which require client YES N/A contact? 15 If yes, was ATI Project Manager notified? YES NO Describe "no" items: Was client contacted? yes / no , If yes, Date: Name of Person contacted: Describe actions taken or client instructions: 'Or other representative documents, letters, and/or shippirq memos