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1534 Willow Pass Road,Pittsburg,CA 94565-1701 <br /> C a m p Pi Analytical, L n C. Toll Free Telephone:(877)252-9262/Fax:(925)252-9269 <br /> "When Quality COunts" http://www.mccampbell.com/E-mail:main@mccampbell.com <br /> Sample Receipt Checklist <br /> Client Name: Safety Kleen Date and Time Received: 6/24/2021 13:50 <br /> Project: OR14384;O'Reilly#2567 BRAKE LATHE SHAVINGS Date Logged: 6/24/2021 <br /> Received by: Valerie Alfaro <br /> WorkOrder Ns: 2106F08 Matrix: Solid Logged by: Valerie Alfaro <br /> Carrier: Laurie Moore(MAI Courier) <br /> Chain of Custody(COC)Information <br /> Chain of custody present? Yes ❑d No ❑ <br /> Chain of custody signed when relinquished and received? Yes ❑d No ❑ <br /> Chain of custody agrees with sample labels? Yes ❑d No ❑ <br /> Sample IDs noted by Client on COC? Yes ❑d No ❑ <br /> Date and Time of collection noted by Client on COC? Yes ❑d No ❑ <br /> Sampler's name noted on COC? Yes ❑ No ❑d <br /> COC agrees with Quote? Yes ❑d No ❑ NA❑ <br /> Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes ❑ No ❑ NA k <br /> Custody seals intact on sample bottles? Yes ❑ No ❑ NA 0 <br /> Shipping container/cooler in good condition? Yes No ❑ <br /> Samples in proper containers/bottles? Yes ❑d No ❑ <br /> Sample containers intact? Yes ❑J No ❑ <br /> Sufficient sample volume for indicated test? Yes ❑d No ❑ <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes No❑ NA❑ <br /> Samples Received on Ice? Yes No❑ <br /> (Ice Type: WET ICE ) <br /> Sample/Temp Blank temperature Temp: 9.2°C NA❑ <br /> ZHS conditional analyses:VOA meets zero headspace Yes ❑ No❑ NA❑d <br /> requirement(VOCs,TPHg/BTEX, RSK)? <br /> Sample labels checked for correct preservation? Yes ❑d No❑ <br /> pH acceptable upon receipt(Metal:<2; Nitrate 353.2/4500NO3: Yes ❑ No❑ NA❑d <br /> <2;522:<4;218.7:>8)? <br /> UCMR Samples: <br /> pH tested and acceptable upon receipt(200.8::52;525.3::54; Yes ❑ No❑ NA❑d <br /> 530:57;541:<3; 544:<6.5&7.5)? <br /> Free Chlorine tested and acceptable upon receipt(<O.1 mg/L)? Yes ❑ No❑ NA❑d <br /> Comments: <br /> Page 15 of 15 <br />