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Amon Laboratories Sample Re.ceipt Checklist <br /> Client Name: 1 Date&Time Received: / <br /> Project Name: <br /> 1 Client Project Number: <br /> Received By: Matrix: Water ❑ Soil Irl Other <br /> Sample Carrier: Client VLaboratory ❑ Fed Ex ❑ UPS ❑ Other ❑ <br /> Argon Labs Project Number: <br /> Shipper Container in good condition? Sufficient sample volume for requested tests?Yes L No ❑ <br /> NIA Q/ Yes ❑ No ❑ Samples received within holding time? Yes No ❑ <br /> Samples received under refrigeration? Yes fid' No ❑ Do samples contain proper preservative? <br /> N/A [� Yes ❑ No ❑ <br /> Chain of custody present? Yes No ❑ VOA vials with preservative? <br /> NIA Yes ❑ No ❑ <br /> Chain of Custody signed by all parties? Yes No ❑ VOA vials preservative type: <br /> HCL ❑ Na2S203 ❑ Other <br /> Chain of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes Imo' No ❑ N/A Yes ❑ No l_ <br /> Samples received in proper containers?Yes No ❑ Samples received intact? Yes L7 No ❑ <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> Date Client Contacted: Person Contacted: <br /> Contacted By: Subject: <br /> Comments: <br /> Action Taken: <br /> ADDITIONAL TEST(S)REQUEST I OTHER <br /> Contacted By: Date: Time: <br /> Call Received By: <br /> Comments: <br /> v.5.02 <br />