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FILTMIDCON'1'[(\CI\T <br />. SAMPLE RECEIPT CHECKLIST <br />Company Name�� <br />Project <br />Lab Number(s) <br />Date/Time Received 7QD <br />Date 1 Time <br />Received by Agcje-e. <br />Carrier Name Lf en <br />Yes No UNPACKING Initials <br />❑ ❑ 6. Chain of custody Present? <br />❑ ❑ 7. Chain of custody includes signatures, dates, and times when relinquished and received? <br />❑ ❑ 8. Chain of custody agrees with bottle count? <br />❑ ❑ 9. Chain of custody agrees with labels? <br />❑ ❑ 10. Samples received within holding times? <br />❑ ❑ 11. Samples in proper container? <br />❑ ❑ 12. Sufficient sample volume for indicated tests? <br />PRESERVATIVE <br />Yes No Initials Yes No Initials <br />❑ ❑ 13. Metals bottle(s) pH < 2? ❑ ❑ 17. TOC bottle(s) pH < 2? <br />❑ ❑ 14. Nutrient bottle(s) pH < 2? ❑ ❑ 18. Oil & Grease bottles) pH < 2? <br />❑ ❑ 15. Cyanide bottle(s) pH > 12? ❑ ❑ 19. Volatiles pH < 2? <br />❑ ❑ 16. Sulfide bottle(s) pH > 9? <br />COMMENTS: <br />F:Urorganic Fomis%SAMPLE RECEIPT CHECKLIST.doc <br />❑ <br />1. <br />Shipping container in good condition? <br />❑ <br />2. <br />Custodyseals ent on shipping container? <br />Condition: ntact Broken <br />❑ <br />("L• <br />3. <br />Ice !Blue Circle one) present in shipping container? <br />T <br />Containers) Temp. 1. IV:6 2, 3. 4. <br />^(Photograph <br />❑ <br />4. <br />Bottles broken and/or leaking? broken bottles.) <br />❑ <br />❑ <br />5. <br />Custody seals on sample bottles) <br />Condition: Intact Broken <br />Yes <br />No <br />LABELING Initials <br />❑ ❑ 6. Chain of custody Present? <br />❑ ❑ 7. Chain of custody includes signatures, dates, and times when relinquished and received? <br />❑ ❑ 8. Chain of custody agrees with bottle count? <br />❑ ❑ 9. Chain of custody agrees with labels? <br />❑ ❑ 10. Samples received within holding times? <br />❑ ❑ 11. Samples in proper container? <br />❑ ❑ 12. Sufficient sample volume for indicated tests? <br />PRESERVATIVE <br />Yes No Initials Yes No Initials <br />❑ ❑ 13. Metals bottle(s) pH < 2? ❑ ❑ 17. TOC bottle(s) pH < 2? <br />❑ ❑ 14. Nutrient bottle(s) pH < 2? ❑ ❑ 18. Oil & Grease bottles) pH < 2? <br />❑ ❑ 15. Cyanide bottle(s) pH > 12? ❑ ❑ 19. Volatiles pH < 2? <br />❑ ❑ 16. Sulfide bottle(s) pH > 9? <br />COMMENTS: <br />F:Urorganic Fomis%SAMPLE RECEIPT CHECKLIST.doc <br />