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Subcontract Satnple Receipt heck]ist <br /> LS Work order Number: 1 <br /> Chain of Custod y 6200109 rmation <br /> Carrier Flame __U5 Yes No <br /> Cain of custody presanl? Yes No <br /> C11a in of custody signed when selinguished nad received? Yes No <br /> Chain of custody agrees with sample labels? Yes <br /> Non-Compliant <br /> S,Rm le ReciriP t lnfeurnatton <br /> Shipping cant2iW/0001cr in good condition? YES <br /> Sanvjcs in Proper container&uttla7 ,es <br /> No Not Present <br /> Sanvlc oontainrrs intact? Non-('omlianl <br /> Yes <br /> St'ffci I sample volume for indicated test? No <br /> Yes � lea <br /> Ssm lc Pre aria sn Uld Tirm H!unL&mj&R <br /> M sanVies received wid'En holding tinsel <br /> Yes Na <br /> Temperature upon rcceipl; _ C <br /> Wet Iee present in Cooler? <br /> Peso <br /> l3Jue Ice present is Cooler? <br /> Yes Na <br /> nsi tics[Re iiretrrent Information <br /> Are aon-Standard efModified methods njucsled? <br /> Subcontract Lib BRTTFw_D For the variQus rnelhads r qutsted? Yes No <br /> Wilt Subcontract Lab be able to rrreel the turn-around time(TAT)requirements" Yes No <br /> Yes No <br /> Subcontract i.s rttfarrnatforl <br /> Work Order Number assigned by Subcontract Lab <br /> Date received at Subcontract Lab <br /> If any items arc check marked NO or are nun-cornpliant, a phone call back to 'California Lnharatary Services is required <br /> irnrrmedfately. If all [teats are seceptable, a f2xed cagy of the signed suit chain of custody(CO and the coinplete4 sample reeeipI <br /> cheek list is required with(n 24 hours of sample receipt. <br /> California Litboratory l3trvicts 3249 Fit2gerald Road Raacho Cordova. CA 95742 Phone (916)638-7341 Fax(916)639-4510 <br /> Page 14 of 14 02/29/2024 <br />