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Rev. 02C Date 11/23 <br />+SunS'� Receiving Form 001A <br />Laboratories, Inc. <br />s� <br />SAMPLE RECEIVING REVIEW SHEET <br />Batch/Work Order #: T2 40-4 4 Z <br />Client Name: A Project: Swfowu/ Fre i SteJ ,'oo A/#, r7o/9 <br />/ 5fat,4ea/ 4CA <br />Delivered by: ❑ Client ❑ SunStar Courier [GLS ❑ FedEx ❑ Other <br />If Courier, Received by: <br />Lab Received by: <br />Total number of coolers received: <br />Date/Time Courier <br />Received: <br />Date/Time Lab <br />r 1 i k e Received: Z Y' SC ('Z : 2, 1 <br />l Thermometer ID: SC -1 Calibration due: 11/17/2024 <br />Temperature: Cooler #1 3, 4 °C +/- the CF (+ 0.1 °C) = <br />Temperature: Cooler #2 °C +/- the CF (+ 0.1 °C) = <br />3 • S °C corrected temperature <br />°C corrected temperature <br />Temperature: Cooler #3 °C +/- the CF (+ 0.1 °C) = °C corrected temperature <br />Temperature criteria =:5 VC <br />Within criteria? es ❑No ❑N/A <br />no frozen containers) <br />If NO: <br />Samples received on ice? ❑Yes ❑No 4 <br />Complete Non -Conformance Sheet <br />If on ice, samples received same day ❑Yes 4 Acceptable []No 4 <br />collected? Complete Non -Conformance Sheet <br />Custody seals intact on cooler/sample <br />Sample containers intact <br />Sample labels match Chain of Custody IDs <br />Total number of containers received match COC <br />Proper containers received for analyses requested on COC <br />Proper preservative indicated on COC/containers for analyses requested <br />Complete shipment received in good condition with correct temperatures, <br />containers, labels, volumes preservatives and within method specified <br />holding times <br />[fYes <br />2(yes <br />[Yes <br />[Yes <br />[Yes <br />❑Yes <br />dYes <br />❑No* <br />❑No* <br />❑No* <br />❑No* <br />❑No* <br />❑No* <br />❑No* <br />DN/A <br />/N/A <br />* Complete Non -Conformance Receiving Sheet if checked Cooler/Sample Review - Initials and date: P 8 <br />Comments: <br />Page I of! <br />