Laserfiche WebLink
Rev.02B Date 08/21 <br /> SunStar Receiving Form 001A <br /> Laboratories, Inc. <br /> Pkovm��ve¢um Ax u rncwi-Ssrew�ces NtirkwmnF <br /> SAMPLE RECEIVING REVIEW SHEET <br /> Batch/Work Order#: J 2 3'9 ` Z <br /> Client Name: po�d4 W Project: L ke�wwj P/4yA <br /> Delivered by: ❑ +Client ❑ SunStar Courier dGLS ❑ FedEx ❑ Other <br /> If Courier, Received by: Date/Time CourierReceived: <br /> l D Lab Received by: Date/Time LabCJGT Received: <br /> Total number of coolers received: Themiameter ID: SC-1 Calibration due : 812123 <br /> Temperature: Cooler#1 7 °C+1- the CF(+0.1°C) = _ °C corrected temperature <br /> Temperature: Cooler 42 °C +1-the CF(+0.1°C) = °C corrected temperature <br /> Temperature: Cooler#3 °C +1-the CF(+0.1°C) = °C corrected temperature <br /> Temperature criteria=c 6°C Within criteria? 3 es ❑No ❑NIA <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? CompJete Non-Conformance Sheet <br /> Custody seals intact on cooler/sample es ❑No* ❑NIA <br /> Sample containers intact dyes ❑No* <br /> Sample labels match Chain of Custody IDs [ Yes ❑No* <br /> Total number of containers received match COC ZYes ❑No* <br /> Proper containers received for analyses requested on CDC QY s ❑No* <br /> Proper preservative indicated on COClcontainers for analyses requested Yes ❑No* ❑NIA <br /> Complete shipment received in good condition with correct temperatures, <br /> containers, labels,volumes preservatives and within method specified lyYes ❑No* <br /> holding times <br /> *Complete Non-Conformance Receiving Sheet if checked Cooler/Sample Review-Initials and date: � 7-�f-23 <br /> Comments: <br /> Page I of i <br /> Page 20 of 23 <br />