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1534 Willow Pass Road,Pittsburg,CA 94565-1701 <br /> VlcCampbell Analytical, Inc. <br /> Web:www.mccampbell.com E-mail:main@mccampbell.com <br /> "When Oualitv Counts" Telephone:877-252-9262 Fax:925-252-9269 <br /> Sample Receipt Checklist <br /> Client Name: MSE Group Date and Time Received: 06/01/09 3:11:36 PM <br /> Project Name: PG&E McDonald ISI Checklist completed and reviewed by: Maria Venegas <br /> WorkOrder N°: 0906008 Matrix Soil Carrier: Client Drop-In <br /> Chain of Custody (COC) Information <br /> Chain of custody present? Yes 0 No ❑ <br /> Chain of custody signed when relinquished and received? Yes No ❑ <br /> Chain of custody agrees with sample labels? Yes ❑ No ❑ <br /> Sample IDs noted by Client on COC? Yes No ❑ <br /> Date and Time of collection noted by Client on COC? Yes R1 No ❑ <br /> Sampler's name noted on COC? Yes R] No ❑ <br /> Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes ❑ No ❑ NA ❑ <br /> Shipping container/cooler in good condition? Yes R1 No ❑ <br /> Samples in proper containers/bottles? Yes R1 No ❑ <br /> Sample containers intact? Yes R1 No ❑ <br /> Sufficient sample volume for indicated test? Yes R1 No ❑ <br /> Sample Preservation and Hold Time(HT) Information <br /> All samples received within holding time? Yes W] No ❑ <br /> Container/Temp Blank temperature Cooler Temp: 18°C NA ❑ <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No ❑ No VOA vials submitted d❑ <br /> Sample labels checked for correct preservation? Yesr❑ No ❑ <br /> TTLC Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No ❑ NA <br /> Samples Received on Ice? Yes `❑ No ❑ <br /> (Ice Type: BLUE ICE ) <br /> "NOTE:If the"No"box is checked, see comments below. <br /> ————————————————————————————————————————————- <br /> -———————————————————————————————————————————— <br /> Client contacted: Date contacted: Contacted by: <br /> Comments: <br />