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Rev.02B Date 08/21 <br /> SSunSta Receiving Form 001A <br /> Laboratories, Inc. <br /> �irAnG Q�Y A�� �os.s x <br /> SAMPLE RECEIVING REVIEW SHEET <br /> Batch/Work Order#: i7.3(1 <br /> Client Name: P1kr*Ker _ Project: Lbw <br /> Delivered by: ❑ Client ❑ SunStar Courier R GLS ❑ FedEx ❑ Other <br /> If Courier, Received by: Date/Time Courier <br /> Received: <br /> Lab Received by: Date/Time Lab <br /> Dow- Received: •� <br /> Total number of coolers received: N Thermometer ID:_SC-1 Calibration due : 812123 <br /> Temperature: Cooler#1 °C +1-the CF(+0.I*C) = °C corrected temperature <br /> Temperature: Cooler#2 °C +1-the CF(+0.I°C) = °C corrected temperature <br /> Temperature: Cooler#3 °C+1-the CF(+p.I°C) = °C corrected temperature <br /> Temperature criteria=c 5°C Within criteria? ❑Yes ❑No [gNIA <br /> no frozen containers <br /> If NO: <br /> Samples received on ice? Dyes ❑No 3 <br /> Complete Non-Conformance Street <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 Yes ❑No* ❑NIA <br /> Sample containers intact ®Yes ❑No* <br /> Sample labels match Chain of Custody IDs 19Yes ❑No* <br /> Total number of containers received match COC ®Yes ❑No* <br /> Proper containers received for analyses requested on COC Ryes ❑No* <br /> Proper preservative indicated on COC/containers for analyses requested ❑Yes ❑No* EiaN/A <br /> Complete shipment received in good condition with correct temperatures, <br /> containers,labels,volumes preservatives and within method specified ® Yes ❑No* <br /> holding times <br /> *Complete Non-Conformance Receiving Sheet if checked Cooler/Sample Review-initials and date: J;Q L(.I o, 2. -� <br /> Comments: <br /> Page 1 of_I <br /> Page 15 of 18 <br />