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,�. MIDCUNT= <br />n SAMPLE RECEIPT CHECKLIST <br />Company Name -p of-- DatelTime Received (0"ZJ,0 — (S / C3cyc:� <br />n„ dale / Tlmo <br />Project Received by �(CC,__ <br />Lab Number(s) 7 "" j Carrier Name <br />to • 3 c t S <br />Yes No UNPACKING initials <br />❑ ❑ 13. Metals bottles) pH < 2? ❑ ❑ 17. TOC bottles) pH < 2? <br />❑ ❑ 14, Nutrient bottle(s) pH < 2? ❑ ❑ 18. Oil & Grease bottle(s) pH < 2? <br />❑ ❑ 15. Cyanide bottle(s) pH > 127 Q ❑ 19. Volatiles pH < 27 <br />❑ ❑ 16. Sulfide bottle(s) pH > 9? <br />COMMENTS: <br />F.Unorganic Forms%SMIPLE RECEIPT CHECKUST.doc <br />❑ <br />1. <br />Shipping container in good condition? <br />❑ <br />❑ <br />2. <br />Custody se sent on shipping container? <br />Condition: Qdac Broken <br />❑ <br />3. <br />Ice / Blue Ice (circle one) present in shipping container? <br />1 <br />10. Samples received within holding times? <br />Container(s) Temp. 1. 2. 3. 4. <br />❑ <br />{I <br />4. <br />Bottles broken and/or leaking? (Photograph broken bottles.) <br />❑ <br />❑ <br />5. <br />Custody seals on sample bottles? <br />Yes <br />No <br />Initials Yes No Initials <br />Condition: Intact Broken i"44 <br />Yes <br />No <br />LABELING Initials <br />❑ ❑ 13. Metals bottles) pH < 2? ❑ ❑ 17. TOC bottles) pH < 2? <br />❑ ❑ 14, Nutrient bottle(s) pH < 2? ❑ ❑ 18. Oil & Grease bottle(s) pH < 2? <br />❑ ❑ 15. Cyanide bottle(s) pH > 127 Q ❑ 19. Volatiles pH < 27 <br />❑ ❑ 16. Sulfide bottle(s) pH > 9? <br />COMMENTS: <br />F.Unorganic Forms%SMIPLE RECEIPT CHECKUST.doc <br />6. Chain of custody Present? <br />tg❑ <br />rA <br />❑ <br />7. Chain of custody includes signatures, dates; and times when relinquished and received? <br />❑ <br />8. Chain of custody agrees with bottle count? <br />❑ <br />9.Chain of custody agrees with labels? <br />❑ <br />10. Samples received within holding times? <br />❑ <br />11. Samples in proper container? <br />❑ <br />12. Sufficient sample volume for indicated tests? <br />PRESERVATIVE <br />Yes <br />No <br />Initials Yes No Initials <br />❑ ❑ 13. Metals bottles) pH < 2? ❑ ❑ 17. TOC bottles) pH < 2? <br />❑ ❑ 14, Nutrient bottle(s) pH < 2? ❑ ❑ 18. Oil & Grease bottle(s) pH < 2? <br />❑ ❑ 15. Cyanide bottle(s) pH > 127 Q ❑ 19. Volatiles pH < 27 <br />❑ ❑ 16. Sulfide bottle(s) pH > 9? <br />COMMENTS: <br />F.Unorganic Forms%SMIPLE RECEIPT CHECKUST.doc <br />