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Service Request No: P070 0 G Client: �`} k `W <br />Samples) delivered by: Client <br />Golden State Overnight <br />Chain of Custody filled out accurately? <br />CAS Emp After Hours DHL <br />Fed X UPS J Other Courier <br />Appropriate sample volume and containers? <br />Sufficient labeling on container(s) ? <br />Container(s) supplied by CAS? <br />Custody seal(s) intact? N/A_ <br />Trip Blank(s) received N/A_ <br />Trip Blank was supplied by CAS <br />Record serial # <br />Yes <br />•✓ <br />No <br />(See Comments) <br />Yes <br />%® <br />No <br />(See Comments) <br />Yes <br />V <br />No <br />(See Comments) <br />-7 <br />Yes <br />No <br />(See Comments) <br />Yes <br />t! <br />No <br />(See Comments) <br />Yes <br />'✓ <br />No <br />/ <br />Yes <br />:! <br />No <br />Temperature of sample(s)/cooler Ll °C Temp Blank? Y or N (Circle One) <br />Voa's Marked Preserved? Yes J No Filled Properly? Yes /No (S-- 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) <br />ASAP Res Cl D.0 Flash Diss S2- Ferrous Fe F & P_ <br />24HR pH Odor Cr+6 <br />48HR BOD Color MBAS Nitrate <br />Nitrite O-PO4 Sett Sol Turbidity <br />72HR Vapors <br />Notified SUE Date & Time _ 0 <br />Container(s) received and their preservative(s): <br />q 75-4()ry--�� WOACL) <br />-uV n C� <br />t N P <br />Comments <br />Initials, Date, Time <br />G ASMO\LOGFORMS\COOLER. DOC <br />u <br />