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FrEMIDCnNTINE�T <br />SAMPLE RECEIPT CHECKLIST <br />Company Name QP -C ftZcr DatelTime Received <br />Date 1 Time <br />Project Received by <br />Lab Number(s) 7 2 _.�._ (?- 2-.L-15 Carrier Name <br />yes <br />No <br />13. Metals bottle(S) pH < 27 _. <br />UNPACKING initials <br />❑ <br />❑ <br />1. <br />Shipping container in good condition? <br />❑ <br />❑ <br />2. <br />Custody seats resent on shipping container? <br />Conditio intact Broken <br />❑ <br />❑ <br />3. <br />Ice I Blue Ice (circle one) present in shipping container? <br />COMMENTS: <br />� 1 <br />nom <br />Container(s) Temp. 1. AJ A 2. 3. 4. <br />❑ <br />,� <br />4. <br />Bottles broken and/or leaking? (Photograph broken bottles.) <br />❑ <br />❑ <br />5. <br />Custody seals on sample bottles? <br />Condition: Intact Broken tJA <br />Yes <br />No <br />LABELING Initials <br />❑ <br />6. <br />Chain of custody Present? <br />❑ <br />7. <br />Chain of custody includes signatures, dates, and times when relinquished and received? <br />❑ <br />8. <br />Chain of custody agrees with bottle count? <br />❑ <br />9. <br />Chain of custody agrees with labels? <br />�J <br />❑ <br />to. <br />Samples received within holding times? <br />❑ <br />11. <br />Samples in proper container? <br />❑ <br />12. <br />Sufficient sample volume for indicated tests? <br />PRESERVATIVE <br />Yes <br />No <br />Initials Yes No Initials <br />❑ <br />❑ <br />13. Metals bottle(S) pH < 27 _. <br />❑ ❑ 17. TOC bottles) pH < 2? <br />❑ <br />❑ <br />14. Nutrient bottle(s) pH < 2? <br />❑ ❑ 18. Oil & Grease bottle(s) pH < 2? <br />❑ <br />❑ <br />15. Cyanide bottle(s) pH > 12? <br />❑ ❑ 19. Volatiles pH < 2? <br />❑ <br />❑ <br />16. Sulfide bottle(s) pH > 9? <br />COMMENTS: <br />� 1 <br />nom <br />FNrnargan c FomssZAMPLE RECEIPT CHECKLIST,doc <br />