Laserfiche WebLink
SAMPLE RECEIPT CHECKLIST <br />Section 1: Lo in # oo Client: Ak'T nt�t <br />g ENT'MrkOY <br />Date Received: fr Project: LON11- <br />Section 2: Samples received In a cooler? , Yes, how many? 2. ❑ No (skip 9 a S below) <br />if no cooler Sample Temp ('C): using Ig Gun # 13 A, or © B <br />© Samples re el ed on ice directly from the field. Cooling process had begun <br />If in cooler: Date Opened I I By (print) G (sign)`__ <br />Shipping Info (if applicable) <br />Are custody seals present? ANo, or ❑ Yes. if yes, where? ❑ on cooler, CI an samples, ❑ on package <br />❑ Date: _ Now many ❑ Signature, ❑ Initials, ❑ Done <br />Were custody seals Intact ulEn arrival? ❑ Yes G No NLA <br />Section 3: Impartmt : Notify PM iftemperature exceeds 66C or arrhm frozen. <br />Packing In cooler: (if other, describe) <br />❑ Bubble Wrap AFoam blacks, Bags, ❑ None, 17 Cloth material, E3 Cardboard, 13 Styrofoam, 13 Paper towels <br />0 Samples received on ice directly from the held. Cooling process had begun <br />Type of ice used : fiLWet, ❑ Blue/Gel, ❑ None Temperature blank(s) Included? ,KYes, © No <br />Temperature measured using Cl Thermometer ID: . or IR Gun # 01 A a <br />cooler Tem 'C): #1: #2: #3: <br />Section 4: YES NO N A <br />Were custody Rapers dry,filled out proeedy, and the ro ect identifiable <br />Were Method 5035 sampling containers resent? <br />If YES, what time were th!X transferred to freezer? <br />3. <br />Did all bottles arrive unbroken/unopened? <br />Are there any missing / extra samples? <br />Are samples in the ap ropriate containers for Indicated tests? <br />Are sample labels present, In good condition and complete? >e <br />Does the container count match the COC? TZ <br />Do the sample labels agree with custody papers? <br />Was sufficient amount of sample sent for tests requested?L <br />Did you change the hold time in LIMS for unpreserved VOAs? <br />Did you change the hold time in LIMS for preserved terracores? <br />Are bubbles a 6mm absent In VOA sam les? <br />Was the client contacted concerning this sample delivery? <br />If YES, who was called? By Date: <br />Section 5: YES NO <br />A <br />Are the samples approerlately preserved? (if N/A, skip the rest of section 5 <br />Did you check preservatives for all bottles for each sample? <br />Did you document your preservative check? <br />pH strip lot# , pH strip lot# , pH strip lot# <br />Preservative added; <br />❑ H2SO4 lot# added to samples on/at <br />❑ HCL lot# added to samples on/at <br />❑ HNO3 lot# added to samples on/at <br />❑ NaOH lot# added to samples _ on/at <br />Section 6: <br />Explanatl ons/Comments: <br />Date Logged In Zi I By (print) (sign) 1 �r_ <br />Date Labe#ed, By (print) (sign) <br />Enthalpy Analytical -Berkeley ; Rev.15, 02j021202B <br />i 4 of 11 <br />