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SAMPLE RECEIPT CHECKLIST <br />Company Name �C-4— oi�rr.�� �i�S"Date/Time Received <br />❑ <br />6. <br />Chain of custody Present? <br />Date Time <br />Project <br />Received by"� <br />1jI <br />Lab Nurnber(s) <br />,� �-� " 7 Z9 �'"� "I Carrier Name <br />t`' -P( -y- <br />❑ <br />UNPACKING <br />Initials <br />Yes No <br />Yes <br />❑/ ❑ 1. <br />Shipping cdntainer in good condition? <br />Samples received within holding times? <br />C 2. <br />❑ <br />Custody seals sent on shipping container? <br />Y e g <br />Condition: ntacl Broken <br />11. <br />❑ (�/ 3. <br />Ice / Blue Ice (circle one) present in shipping container? <br />_ <br />7 <br />Container(s) Temp. 1. A-4 2. 3. 4. <br />❑ [�% 4. <br />Bottles broken and/or leaking? (Photograph broken bottles.) <br />❑ ❑ 5. <br />Custody seals on sample bottles? <br />Condition: Intact Broken <br />Yes No <br />LABELING <br />Initials <br />[]% <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 />❑ <br />to. <br />Samples received within holding times? <br />❑ <br />11. <br />Samples in proper container? <br />X❑ <br />12. <br />Sufficient sample volume for indicated tests? <br />PRESERVATIVE <br />Yes No Initials Yes No Initials <br />❑ ❑ 13. Metals botfle(s) pH < 2? ❑ ❑ 17. TOC bottle(s) pH < 2? <br />❑ ❑ 14. Nutrient bottles) pH < 2? _ ❑ ❑ 18. Oil & Grease bottle(s) pH < 2? <br />❑ ❑ 15. Cyanide bottles) pH > 12? ❑ ❑ 19. Volatiles pH < 2? <br />❑ ❑ 16. Sulfide bottle(s) pH > 9? <br />COMMENTS:IjCY <br />F:Unorganlc FormslSAMPLE RECEIPT CHECKLIST.doc <br />