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LAk <br /> ASSOCIATED LABORATORIES <br /> 806 North Batavia-Orange, California 92868- 714-771-6900 FAX 714-538-1209 <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Section 1 <br /> Client: Project: <br /> Date Received: ll ► ►t Sampler's Name: Yes jjjp2 <br /> Sample(s) received in cooler: Ue No (Skip Section 2) <br /> Shipping Information: <br /> -Section 2 <br /> Was the cooler packed with: Ice Ace Packs _Bubble Wrap —Styrofoam <br /> Paper None _Other <br /> Cooler or box temperature: <br /> (Acceptance range is 2 to 6 Deg. C.) <br /> Section 3 YES NO N/A <br /> Was a COC received? V <br /> Is it properly completed? (IDs, sampling date and time, signature,test) ✓ <br /> Were custody seals present? <br /> If Yes-were they intact? <br /> Were all samples sealed in plastic bags? ✓ <br /> Did all samples arrive intact?If no,indicate below. v <br /> Did all bottle labels agree with COC? (ID, dates and times) ✓ <br /> Were correct containers used for the tests required? <br /> Was a sufficient amount of sample sent for tests indicated? <br /> Was there heads ace in VOA vials? <br /> Were the containers labeled witli cOITectp:reservatives? � <br /> Was total residual chlorine measured(Fish Bioassay samples only)? <br /> *: If the answer is no,please inform Fish Bioassay Dept. immediately. <br /> Section 4 <br /> Explanations/Comments <br /> Section 5 <br /> Was Project Manager notified of discrepancies: Y / N N/A <br /> Completed By: Date: 1 l 1 l t <br />