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Rev.02 Date 07/19 <br /> Silly Receiving Form 00 1 <br /> I <br /> Laboratories, Inc. <br /> V�_�Vfw QuAts"MUVTIC,44 "q&OWM <br /> SAMPLE RECEIVING REVIEW SHEET <br /> Batch/Work Order <br /> Client Name: WGR Southwest. Inc. prQject: <br /> NuStar Terminal <br /> Delivered by, [�J ('Jienf DSonStarCourier F]GLS D FedEx [:1 UPS <br /> If Courier, Received by: Date/Time Courier <br /> Received: <br /> Lab Received by: Brian Date/Time Lab 3-9-21 13:58 <br /> Received: <br /> Total number of coolers received- Themionieter ID: I Calibration due 8/17/21 <br /> Temperature: Cooler 41 19 the CIF 0.2°C) = 2.7 'C corrected temperature <br /> Temperature: Cooler#2 11C the CF 0.20C) 'C corrected temperature <br /> Temperature: Cooler#3 OC the CF 0.2°C) 'C corrected temperature <br /> Temperature criteria=5 6*C Within criteria`? Eyes nNo F1N/A <br /> {no 1'roxen containers) <br /> If NO: <br /> Samples received on ice? Dyes [:]No 4 <br /> Complete Non-Conformance Sheet <br /> If on ice,samples received same day FjYes 4 Acceptable nNo 4 <br /> collected? Complete-Non-Conformance Sheet <br /> Custody seals intact on cooler/sample nYes F]No* ®N/A <br /> Sample containers intact Eyes nNo* <br /> Sample labels match Chain of Custody IDs EYes nNo* <br /> Total number of container-,received match COC OYes nNo* <br /> Proper containers received for analyses requested on COC Eyes nNo* <br /> ['toper preservative indicated on CCS'/containers for analyses requested Dyes F]No* EN/A <br /> Complete shipment received in good condition with correct temperatures, <br /> containers, labels,volumes preservatives and within method specified Z Yes nNo* <br /> holding times <br /> • Complete Non-Conformance Receiving Sheet it-checked Cwler.?Sample Review-Initials and date: DM 3-19-21 <br /> Comments: <br /> Pzwe I of I <br /> Page 100 of 105 <br />