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Rev.02B Date 09/21 <br /> SunStar Receiving Form 001 A <br /> Laboratories, Inc. <br /> ftUVRIINO QPAu"ANALMCAL URV IC"NATtU"l1* <br /> SAMPLE RECEIVING REVIEW SHEET <br /> Batch/Work Order#: ?-319 I b p <br /> Client Name: �kr4r'- Project: L-nCem*J r iazd <br /> Delivered by: ❑ Client ❑ SonStar Courier W GLS ❑ FedFx ❑ Other <br /> If Courier, Received by: Date/Time Courier <br /> Received: <br /> Lab Received by: Date/Time Lab <br /> Tra <br /> �r ve Received: -7r- �-2-3 <br /> Total number of coolers received: Thermometer ID: SC-I Calibration due : 812123 <br /> Temperature: Cooler#1 °C+1-the CIF(+0.1 QC) = °C corrected temperature <br /> Temperature: Cooler#2 °C the CIF(+0.1°C) = °C corrected temperature <br /> Temperature: Cooler#3 °C+1-the CF(+O.I°C) = °C corrected temperature <br /> Temperature criteria=c 6°C <br /> r►o frozen containers) Within criteria. ❑Yes ❑Nn NIA If NO: <br /> Samples received on ice? Dyes ❑No <br /> Complete Non-Conformance Sheet <br /> If on ice,samples received same day ❑No 4 <br /> collected? ❑� es Acceptable Com lete Non-Conform nce Sheet <br /> Custody seals intact on cooler/sample Yes ❑No* A T� 7-0-7-3 <br /> Sample containers intact [ Yes ❑No* <br /> Sample labels match Chain of Custody lDs [► Yes ❑No* <br /> Total number of containers received match COC [ Yes ❑No* <br /> Proper containers received for analyses requested on CDC des ❑No* <br /> Proper preservative indicated on COClcontainers For analyses requested []Yes ❑No* d/A <br /> Complete shipment received in good condition with correct temperatures, <br /> containers, labels,volumes preservatives and within method specified dyes ❑No* <br /> holding times <br /> *Complete Nan-Conformance Receiving Sheet if checked Cooler/Sample Review- Initials and date: 7. 3 <br /> Comments: <br /> Page 1 of <br /> Page 23 of 33 <br />