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Amon Laboratories Sample Receipt Checklist <br /> Client Name ATC Associates, Inc Date&Time Received 4/12/2004 1535 <br /> Project Name West Lane Fuels Client Project Number 54 26874 0001 <br /> Received By D S Matrix Water ❑ Soil ❑ <br /> Sample Carrier Client ❑ Laboratory Q Fed Ex ❑ UPS' ❑ Other ❑ <br /> Argon Labs Project Number E04291 <br /> Shipper Container in good condition? Samples received in proper containers? Yes No ❑ <br /> NIA Yes P-1 No ❑ Samples received intact? Yes Q No ❑ <br /> Samples received under refrigeration? Yes 0 No ❑ Sufficient sample volume for requested tests?Yes ❑ No ❑ <br /> Chain of custody present Yes 0 No Samples received within holding time? Yes 0 No ❑ <br /> Chain of Custody signed by all parties? Yes No ❑ Do samples contain proper preservative? <br /> NIA ❑ Yes No ❑ <br /> Chain of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes [] No ❑ (None submitted ❑} Yes Q No ❑ <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> iDate Client Contacted Person Conacted <br /> Contacted By Subject <br /> Comments <br /> Action Taken <br /> ADDITIONAL TEST(S)REQUEST I OTHER <br /> Contacted By Date Time <br /> Call Received By <br /> Comments <br />