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ASSOCIATED C TED LABORATORIES <br />806 North Batavia - Orange, California 92868 - 714-771-6900 <br />SAMPLE ACCEPTANCE CHECKLIST <br />Section 1 <br />Client: /H I pias, <br />Date Received: —7/14 ' I1 <br />Sample(s) received in cooler: Yes <br />Shiiminu- Information: <br />Section 2 <br />Was the cooler packed with <br />Cooler or box temperature: <br />(Acceptance range is 2 to 6 Deg. C.) <br />FAX 714-538-1209 <br />Project: <br />Sampler's Nalne: Yes <br />(Skip Section 2) <br />Ice Ice Pcks _ Bubble Wrap _ Styrofoam <br />Paper __ Non I Other <br />Section 3 <br />Was a COC received? <br />YF.S <br />NO N/A <br />v <br />Is it properly completed? (IDs, sampling date and time, signature, test) <br />N/ <br />Were custody seals resent? <br />If Yes - were they intact? <br />Were all samples sealed in plastic bags? <br />v <br />Did all samples arrive intact? If no, indicate below. <br />v <br />Did all bottle labels agree with COC? (ID, dates and tunes) <br />✓ <br />Were correct containers used for the tests required? 1, <br />v <br />Was a sufficient amount of sample sent for tests indicated? <br />Was there heads ace in VOA vials? <br />Were the eotltalners labeled with correct preservatives`.' <br />Was total residual chlorine measured (Fish Bioassaysamples only)? * <br />v <br />It the answer is no, please inform Fish Bioassay IJP V. immediately. <br />IIS <br />Section 4 <br />Ex lanations/Comments <br />Section 5 <br />Was Project Manager notified of discrepancies: Y ; N N/A <br />Completed By: Date: -7/ iy i t I <br />