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1 <br /> Amon Laboratories Sample Receipt Checklist <br /> Client Name ATC Associates, Inc Date&Time Received 1/15/2004 1655 <br /> Project Name West Lane Fuels Client Project Number 54 26874 0001 <br /> Received By P H Matrix Water [] Sall ❑ <br /> Sample Carrier Client ❑ Laboratory EE Fed Ex ❑ UPS ❑ Other ❑ <br /> Argon Labs Pro)ect Number E01271 <br /> Shipper Container in good condition? Samples received in proper containers? Yes Q No ❑ <br /> NIA Yes No ❑ Samples received intact? Yes No ❑ <br />' Samples received under refrigeration? Yes ❑ No ❑ Sufficient sample volume for requested tests?Yes [] No ❑ <br /> Chain of custody present? Yes 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 Q No ❑ <br /> Cham of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes El No ❑ (None submitted ❑ ) Yes No ❑ <br /> --ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> Date Client Contacted Person Conacted <br /> Contacted By Subject <br /> Comments <br /> Action Taken <br /> ADDITIONAL TEST(S)REQUEST 1 OTHER <br /> Contacted By Date Time <br /> Call Received By <br /> Comments <br />