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Rev.02B Date 08121 <br /> sun Star Receiving Form 001 A <br /> Laboratories, Inc. <br /> Pkwrrwnc Q�um AKurnC u_36iv1rHs NA[xw+nbF <br /> SAMPLE RECEIVING REVIEW SHEET <br /> Batch[Work Order#: T2319 , <br /> Client Name: P Project: L ke wwj y <br /> Delivered by: ❑ Client ❑ SunStar Courier dGLS ❑ FedEx ❑ Other <br /> If Courier, Received by: Date/Time CourierReceived: <br /> Lab Received by: Date/Time Lab Received: <br /> Total number of coolers received: Thermometer 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? es ❑No ❑NIA <br /> no frozen containers <br /> If NO: T <br /> Samples received on ice? Dyes ❑No <br /> Complete Non-C'oul'ormance Sheet <br /> If on ice,samples received same day ❑Ye' 4 Acceptable [—]No 4 <br /> collected? Cornpjete Non-Conformance Sheet <br /> Custody seals intact on cooler/sample E3fes ❑No* ❑N/A <br /> Sample containers intact R(YYes ❑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 Y s ❑No* <br /> Proper preservative indicated on COC/containers 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 ZYes ❑No* <br /> holding times <br /> r <br /> *Complete Non-Conformance Receiving Sheet if checked Cooler/Sample Review-Initials and date: I l 7—r j 23 <br /> Comments: <br /> Page 1 of <br /> Page 20 of 23 <br />