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Subcontract Sample Receipt Checklist <br /> CLS Work Order Number: <br /> Chain of Custt3d v C4C Information <br /> Carrier lwanxe CA5 Yes No <br /> Chain of custody prestnt? Yes No <br /> Chain of custody signed ►often relinquished and received? Yes No <br /> Chain of custody agrees with sample iabel5? Yes Nan-Corpliant <br /> Sample Receipt Information <br /> Shipping container/cooler in good condition? Yes NO Not Present <br /> Samples in propel containerlbottle? Yes y{ Non-Compliant <br /> Sample containers intact? Yes No <br /> Sufficient sample volunx for indicated test? Yes NO <br /> Sample Preservation and Hold Time LHT1 Information <br /> All samples rteeived within holding fimO Yes ` No <br /> Temperature upon receipt: _ C <br /> Wet Ice present in Cooler? Yes No <br /> E31vc Ice present in Coolct? Yes � � Na <br /> Analytical Re uirempnt info ation <br /> Am nurL-Standard of Modified methods xequested? Yes NO <br /> Subcontract Lab CERTIFIED for the various rnethDds requested? Yes No <br /> MR Subcontract Lab be able to meet the lum-around time(TAT)requiremenis? Yes No <br /> Subcontract Lab Informatian <br /> Work Order Numbcr assigned by S ubconuact Lab <br /> Tate received at Subcontract Lab <br /> If arty items are check alArked NO or are Stott-compliant, a phone tall bade to California Laboratory Services is required <br /> immediately. If all items are acceptable, a faxed copy of tine signed sub chain of custody(COC) and (lie completed sample receipt <br /> cheek list is required within 24 hours of sample receipt, <br /> California Laboratory Smices 3249 Fitxgorald Road Rancho Cordova, CA 95742 Phorte(916)638-7301 pax(916) 638-451 Q <br /> Page 6 of 6 02/14/2024 <br />