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—i <br /> McCamplbell Analyti„gI Inc. Tcus34 Willowr o=c�iasz-M2/F�:i�)u2-�9 <br /> when counts" hnp;twww.mecampbcii.com/E-m�7l.main@mm mpbell.wm <br /> Sample Receipt Checklist <br /> Client Name: Stockton Rubber Mfg.Co.,Inc. Date and Time Received: 7/21201211:12:00 AM <br /> Project Name: #11076AN003;Pre-polymer Residue Determination Login Reviewed by. Maria Venegas <br /> WorkOrder N`: 1207007 Matrix: Solid Carrier: IPS <br /> Ghain of Custody(COC)Information 0-COVED <br /> 1 <br /> Chain of custody present? Yes ® No❑ RL .. <br /> Chain of custody signed when relinquished and received? Yes ® No❑ <br /> SEP 3 0 2016 <br /> Chain of custody agrees with sample labels? Yes ® No❑ <br /> Sample Ips noted by Client on COC? Yes ® No❑ ENVIRONMENTAL HELT <br /> Date and Time of collection noted by Client on COC? Yes ® No❑ <br /> DEPARTMENT <br /> Sampler's name noted on COC? Yes ® No❑ <br /> Sample Receipt infomatlon <br /> Custody seals intact on shipping container/cDoler? Yes ❑ No❑ NA <br /> Shipping container/cooter in good condition? Yes No❑ <br /> Samples in proper containersibottles? Yes ® No❑ <br /> Sample containers intact? Yes ® No❑ <br /> Sufficient sample volume for indicated test? Yes ® No❑ <br /> MRIe Prsaenration and Hold Time(HT)Information <br /> All samples received within holding time? Yes ®. No❑ <br /> Container/Temp Blank temperature Cooler Temp: NA <br /> Water-VOA vials have zero headepeoe/no bubbles? Yes ❑ No❑ No VOA vials submitted <br /> Sample labels checked for coned preservation? Yes ® No❑ <br /> Metal-pH sooeptabie upon receipt(pH c2)? Yes ❑ No❑ NA <br /> Samples Received on Ice? Yes ❑ No <br /> i <br /> •NOTIF:if the"ft"box Is checked,see comments below. <br /> --------------------------------------------------- <br /> --------------------------------------------- <br /> Comments: <br /> Page 4 of 5 <br />