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46/30/2011 16:32 714-77199' ASSOCIATED LABS PAGE 05/05 <br />LAM\ ASSOCIATED LABORATORIES <br />806 North Batavia — Orange, California 92868 — 714771-6900 <br />SAMPLE ACCEPTANCE CHECKLIST <br />FAX 714-538-1209 <br />Section <br />Client-. i� l Al -i�7t OmW e4& j <br />Pro ect: <br />Date Received--__ Sampler's Naine; Ves Project:— <br />No <br />Sample(s) receved in cooler: Yes kip Section 2) <br />Shipping Information <br />Sections 2 <br />Was the cooler packed with <br />Cooler or box temperature: <br />Ice _ Ice Packs Bubble Wrap _ Styrofoam <br />Paper _ None _ Other <br />(Acceptance range is 2 to 6 Deg. C.) <br />Section 3 <br />Was a COC received? <br />Is it properly completed? (IDs, sampling date azid tune, signature, test) <br />Were custody seals present? <br />If Yes — were they intact? <br />Were all samples sealed in plastic bags? <br />Did all samples arrive intact? If no, indicate below. <br />Did all bottle labels agree with COC? (ID, dates and times) <br />Were correct containers used for the tests requited? <br />Was a sufficient amount of sarrrple sent for tests indicated2 <br />Was there heads ace in VOA vials? <br />Were the cont:ainei's labeled with cot -rest prese�vatives? <br />Was total residual chlorine measured (Fish Bioassay samples Drily)? <br />*: If the answer is no, please inform Fish Bioassay Dept. immediately. <br />Section 4 <br />Section 5 <br />Was Project Manager notified of discrepancies: Y /T N/A <br />Completed By: d`" i� Date: �� <br />YES 1 NO i N/A <br />