Laserfiche WebLink
Rev. 02C Date 11/23 <br />SunS Receiving Form 001A <br />Laboratories'. Inc. <br />SAMPLE RECEIVING REVIEW SHEET <br />Batch/Work Order #: T2y v7=J y 1 <br />Client Name: <br />Delivered by: <br />If Courier, Received by: <br />Lab Received by: <br />Project: Saftyw/ Fre I Ste,+ We. I <br />hoc 'ase � <br />❑ Client ElSunStar Courier [if/GLS ElFedEx EJOther C14 <br />41 ke <br />Date/Time Courier <br />Received: <br />Date/Time Lab <br />Received: 2�q�11-=' (2: Z <br />Total number of coolers received: I Thermometer ID: SC -1 <br />Temperature: Cooler # 1 3, 4 °C +/- the CF (+ 0.1 °C) = <br />Calibration due: 11/17/2024 <br />3-.5 °C corrected temperature <br />Temperature: Cooler #2 °C +/- the CF (+ 0.1 °C) = <br />°C corrected temperature <br />Temperature: Cooler #3 °C +/- the CF (+ 0.1 °C) = <br />°C corrected temperature <br />Temperature criteria =!S VC Within criteria? <br />5Kes <br />[:]No ❑N/A <br />no frozen containers <br />If NO: <br />Samples received on ice? ❑Yes <br />❑No 4 <br />Complete Non -Conformance Sheet <br />If on ice, samples received same day ❑Yes Acceptable <br />❑No 4 <br />collected? <br />Complete Non -Conformance Sheet <br />Custody seals intact on cooler/sample <br />[ Yes <br />❑No* DN/A <br />Sample containers intact <br />[Yes <br />❑No* <br />Sample labels match Chain of Custody IDs <br />["l Yes <br />❑No* <br />Total number of containers received match COC <br />[dyes <br />❑No* <br />Proper containers received for analyses requested on COC <br />[Yes <br />[]No* <br />/N/A <br />Proper preservative indicated on COC/containers for analyses requested <br />❑Yes <br />❑No* <br />Complete shipment received in good condition with correct temperatures, <br />containers, labels, volumes preservatives and within method specified <br />dYes <br />❑No* <br />holding times <br />* Complete Non -Conformance Receiving Sheet if checked Cooler/Sample Review - Initials and date: P s 2�tV1, <br />y <br />Comments: <br />I E <br />1!!!(949) 297-5020 0 w-ww.sunstarlabs.com 0 25712 Commercentre Drive 0 Lake Forest. C:' " lft J <br />