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��. 1534 Willow Pass Rued,PittsW&CA 44565-1701 <br /> McCampbell Analytical, Inc. Toll FmTeiq*one:(877)252-9262/F=(925)252-4264 <br /> nWhen teat Counts r, hftpJ/www mxampbe8.wm/6-maiL•mainQt=rwbelLcm <br /> Sample Receipt Checklist <br /> Client Name: Stockton Rubber Ntfg.Co.,Inc. Date and Time Received: 1111&12012 7:01:36 PM <br /> Project Name: Sandblast Login Reviewed by: Zoralda Cortez <br /> WorkOrder N': 1211461 Matrix S"i Carrier. David Valles(MAI Courler) <br /> Chain of Cult*j=1 I (yr+ation <br /> Chain of custody present? Yes ® No❑ <br /> RECEIVED <br /> Chain of custody signed when relinquished and received? Yes ® No❑ <br /> Chain of custody agrees with sample labels? Yes ® No F] SEP 2016 <br /> Sample IDs noted by Client on COC? Yes ® No❑ <br /> Date and Time of collection noted by Client on COC? Yes ® No❑ ENVIRONMENTAL HEALTH <br /> FART T <br /> Sampler's name noted on COC? Yes ® No El <br /> sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes ® No❑ NA❑ <br /> Shipping contalner/cooler in good condition? Yes ® No❑ <br /> ' Samples in proper containeWbottles? Yes ® No❑ <br /> Sample containers Intact? Yes ® No❑ <br /> Sufficient sample volume for Indicated fest? Yes 0 No❑ <br /> r <br /> Sample situ mien and Hold Time(Nn Intogistion <br /> All samples received within holding time? Yes ® No❑ <br /> Contalner/Temp Blank temperature Cooler Temp: 0.8°C NA❑ <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ No VOA vials submitted <br /> Sample labels checked for correct preservation? Yes Q No❑ <br /> Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA <br /> Samples Received on Ice? Yes ® No❑ <br /> (Ice Type: WET ICE ) <br /> "NOTE:lithe"No"box 1s checker!,sea comments below. <br /> --------------------------------------------- <br /> --------------------------------------------- <br /> Comments: <br /> Page 4 of 6 <br />