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SAMPLE RECEIPT FORM <br /> Service Request No: L0600qq(p Client: s� <br /> r <br /> Sample(s) delivered by: Client CAS Emp After Hours DHL <br /> Golden State Overnight Fed X UPS Other Courier <br /> Chain of Custody filled out,accurately? Yes No <br /> (See Comments) <br /> Appropriate sample volume and containers? Yes No (See Comments) <br /> Sufficient labeling on container(s) ? Yes v1No (See Comments) <br /> Container(s) supplied by CAS? Yes `� No (See Continents) 1 <br /> Custody seal(s) intact? N/A Yes No (See Comments) <br /> Trip Blanks) received Yes No <br /> If Trip Blank was supplied by CAS, record serial # -TB <br /> Temperature of sample(s)/cooler +- _°C Temp Blank? Y o&Circle One) <br /> Voa's Marked Preserved? Yes V/ No Filled Properly? Yes ✓ No (See Comments) <br /> Preserved Bottles Requiring pH check(s)? Yes Appropriate Preservation? Yes No <br /> RUSH Turn around time? Yes Notified Date&Time <br /> Short Hold-Time Analysis (check all that apply) 1 <br /> ASAP Res Cl D.O Flash Diss S2- Ferrous Fe <br /> 24HR pH Odor Cr+6 1 <br /> 48HR BOD Color MBAS Nitrate <br /> Nitrite O-PO4 Sett Sol Turbidity <br /> 72HR Vapors 1 <br /> Notified Date&Time <br /> Container(s) received and theirr <br /> p eservative(s): <br /> 3- qDmL Vvk (#V ) <br /> -4 � VOA- <br /> Comments <br /> Initials_ nate. Time <br />