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Ic14Willo,. Pi-Road Pittshurg C, 045(,q-1'701 Analytical, Inc. Web:www.mccampbell.com E-mail:main(�mccampbell.com <br /> 1W' "When Quality Counts" I Telephone:877-252-9262 Fax:925-252-9269 <br /> Sample Receipt Checklist <br /> Client Name: Safety Kleen Date and Time Received: 711/2011 5:25:47 PM <br /> Project Name: Booth Filters,PAPE Checklist completed and reviewed by: Angela Rydelius <br /> WorkOrder N°: 1107029 Matrix: Solid Carrier: FedEx <br /> Chain of Custody(COC)Information <br /> Chain of custody present? Yes ❑d No❑ <br /> Chain of custody signed when relinquished and received? Yes ❑ No❑./ <br /> Chain of custody agrees with sample labels? Yes W No❑ <br /> Sample IDs noted by Client on COC? Yes No❑ <br /> Date and Time of collection noted by Client on COC? Yes No❑ <br /> Sampler's name noted on COC? Yes 0 No❑ <br /> Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes I'll No❑ NA❑ <br /> Shipping container/cooler in good condition? Yes No❑ <br /> Samples in proper containers/bottles? Yes No❑ <br /> Sample containers intact? Yes No❑ <br /> Sufficient sample volume for indicated test? Yes ❑ No❑ <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes O No❑ <br /> Container/Temp Blank temperature Cooler Temp: NA❑� <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No❑ No VOA vials submitted <br /> Sample labels checked for correct preservation? Yes ❑d No❑ <br /> Metal-pH acceptable upon receipt(pH<2)? Yes ❑ No❑ NA❑ <br /> Samples Received on Ice? Yes ❑ No❑� <br /> NOTE:If the"No"box is checked,see comments below. <br /> -------------------- --- -- --- --- - -- - - - - - - - -- --- <br /> Client contacted: Date contacted: Contacted by: <br /> Comments: <br /> Page 4 of 6 <br />