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r <br />SAMPLE RECEIPT FORM <br />rService <br />Request No: Po%®D I1 Client: <br />rSample(s) <br />delivered by: Client CAS Emp <br />After Hours DHL <br />Golden State Overnight Fed X <br />UPS r'Other Courier <br />Chain of Custody filled out accurately? Yes <br />No (See Comments) <br />Appropriate sample volume and containers? Yes <br />No (See Comments) <br />Sufficient labeling on container(s) ? Yes <br />✓ No (See Comments) <br />Container(s) supplied by CAS? Yes <br />iSNo (See Comments) <br />Custody intact? N/A <br />seal(s) Yes <br />No (See Comments <br />Trip Blank(s) received Yes <br />No 1/ <br />If Trip Blank was supplied by CAS, record serial # -TB- <br />Temperature of sample(s)/cooler °C <br />Temp Blank. Y r N (Circle One) <br />Voa's Marked Preserved? Yes �No Filled Properly? Yes t--,--No (See Comments) <br />Preserved Bottles Requiring pH check(s)? Yes �' Appropriate Preservation? Yes No <br />RUSH Turn around time? Yes Notified <br />Date & Time <br />rShort <br />Hold-Time Analysis (check all that apply) <br />ASAP Res Cl D.O Flash <br />Diss S2- Ferrous Fe <br />24HR pH Odor Cr+6 <br />48HR BOD Color MBAS <br />/ <br />Nitrate <br />r <br />Nitrite O-PO4 Sett Sol <br />Turbidity <br />72HR Vapors <br />r <br />Notified 56 rl 2 - <br />Date &Time <br />Container(s) received and their preservative(s): <br />r� <br />rComments <br />c / <br />Z <br />Initials, Date, Time~ /��:\ <br />�sM0\LOGFORMs\COOLER.DOC <br />,F <br />