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WE <br />La eIo: 1 2 <br />Columbia Analytical Services, Inc. <br />PC <br />Cooter Receipt and Preservation Form <br />Client / Project: Service quest K07 <br />-4ened: <br />® <br />Received: b-p� By: J` <br />I. <br />Sampleswere received via? US Mall Fed Ex DHL G GS PDX Courier Hand Delivered <br />2. <br />Samples were received in: (circle) Col Box Envelope Other <br />NA <br />3. <br />Were custody seals on coolers? NA Y (9 If yes, how many and where? <br />If present, were custody seals intact? Y N If present, were they// sig d and dated? <br />Y N <br />4. <br />Is shippe 's air-bill fled? If not, record air-bill number: 1 [ F I f �` ��/, U <br />�1 MO K.lu�� <br />NA N <br />5. <br />Temperature of cooler(s) upon receipt (°C): <br />Temperature Blank (°C): <br />6. <br />If applicable, list Chain of Custody Numbers: <br />7. <br />Were custody papers property Iled out (ink, signed, etc.)? <br />NA N <br />8. <br />Packing material used. e s B ble rap Gcks Wet ice Sleeves Other <br />9. <br />Did all bottles arrive in good condition unbroken)? Indicate in the table below. <br />NA N <br />10. <br />Were all sample labels complete (Le analysis, preservation, etc.)? <br />N <br />11. <br />Did all sample labels and tags agree with custody papers? Indicate in the table below <br />N <br />12. <br />Were the correct types of bottles used for the tests indicated? <br />NA N <br />13. <br />Were all of the preserved bottles received at the lab with the appropriate pH? Indicate in the table below <br />_ bA Y N <br />14. <br />Were VOA vials and 1631 Mercury bottles checked for absence of air bubbles? Indicate in the table below. <br />Y N <br />15. <br />Are CWA Microbiology samples received with >1/2 the 24hr. hold time remaining from collection? <br />181 Y N <br />C1k <br />16. <br />Was C12/Res negative? <br />Y N <br />Sam�leE�.dn:;BotEt�, -:..: <br />;::-;. a n GCF'G: <br />S mgle.ID.o :: <br />:.::...:.... <br />te. ;an Bottle: i <br />Sant {[} <br />::... tz <br />lD <br />Barri' (e on COG <br />WE <br />La eIo: 1 2 <br />