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SAMPLE RECEIPT FORM <br /> Service Request No: L060 <br /> q 154 Client: _ I <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 t/ No (See Comments <br /> Appropriate sample volume and containers? Yes ✓ No (See Comments) <br /> Sufficient labeling on container(s) ? Yes ✓ No (See Comments) <br /> Container(s) supplied by CAS? Yes ✓ No (See Comments) <br /> Custody seal(s) intact? N/A Yes No (See Comments) <br /> Trio Blanks) received Yes No <br /> If Trip Blank was supplied by CAS, record serial # -TB- <br /> Temperature of sample(s)/cooler C Temp Blank?&N (Circle One) <br /> Voa's Marked Preserved? Yes V No Filled Properly?Yes ✓ No (See Comments) <br /> Preserved Bottles Requiring pH check(s)? Yes V Appropriate Preservation?Yes V No <br /> RUSH Turn around time? Yes Notified Date & Time <br /> Short Hold-Time Analysis (check all that apply) <br /> ASAP Res Cl D.O Flash Diss S2- Ferrous Fe <br /> 24)i3R pH Odor Cr+6 <br /> 48HR BOD Color MBAS Nitrate V <br /> Nitrite O-PO4 Sett Sol Turbidity <br /> 72HR Vapors <br /> Notified ( � l Wt� Date&Time—1 In lo <br /> Container(s) received and their preservative(s): <br /> F31— DmI 040W-) -2 \j0A,(kCL) <br /> 1 -- 1L. PL (NP) I--IL RL (NP) <br /> I -b6b m l P L (4N63) t - tri PL(H-vv3) <br /> 2 .4c)N( v6 A-C 4(L) <br /> Comments <br /> �' n <br /> 1 <br /> 56 <br />