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EMAX-SM02 <br />Rev. 3 <br />Appendix 2 <br />SAMPLE RECEIPT FORM i <br />Type of Delivery <br />Delivered B /Airbill ECN <br />®6 i <br />❑ EMAX Courier <br />Rece lent <br />a <br />Client Delivery <br />Date <br />. O - <br />�❑ <br />�:qWird Party �' <br />Time <br />l C-0 <br />COC Inspection <br />Q-- lent Name QI--Sampler Name <br />Q Address ❑ Courier Signature/Date/-rime <br />}-Client Pm/FC TAT <br />Tel #/Fax # EtlSample ID <br />Safety Issues None ❑ High Concentrations expected <br />Comments: n Rarf Srraaninn Ran tirari <br />Sampling Date/Tine/Location <br />P Analysis Required <br />-matrix <br />Preservative (if any) <br />❑ Superfund Site Samples <br />Container <br />Condition <br />Packaging <br />Temperatures <br />Comments: <br />cooler <br />❑ Custody Seal <br />[;-Babble Pack <br />'Cooler i <br />❑ Cooler 5 <br />❑ Cooler 9 <br />Packaging Inspection <br />F-1Box❑ <br />Intact ❑ Damaged <br />❑ Styrofoam E-50-fficient <br />❑ Cooler 2 ❑ Cooler 3 <br />❑ Cooler 6 ❑ Cooler 7 <br />❑ Cooler 10 ❑ Cooler 11 <br />❑ <br />❑ <br />E�-p t� --j, <br />❑ Cooler 4 <br />❑ Cooler 8 <br />❑ Cooler 12 <br />LSCID <br />Client ID <br />Discre a <br />Corrective AcjiQji <br />V 2 oes ou <br />W <br />L2) v r ffS <br />�tZ <br />of o 01 11 <br />f 1, <br />�3 V i �tj <br />k-(, (� �^litbic e- C -t"^ <br />LSCID : Lab Sample Container ID <br />REVIEWS <br />Sample Labeling <br />Date <br />SRF PM <br />Date 016 Date <br />m <br />