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MIDCONTINBNT <br />p SAMPLE RECEIPT CHECKLIST <br />Company Name .00 DatelTime Received f '" 2-6 <br />Date 1 Tim <br />Project a. e A Received by <br />Lab Numbers) �J L} (--7 V i /-1-97- 15 Carrier Name GV15 <br />Y" No UNPACKING fniNals <br />PRESERVATIVE <br />Yes No Mltws Yes No brl ws <br />❑ ❑ 13. Metals bottle(s) pH < 2? ❑ ❑ 17. TOC bottle(s) pH < 2? <br />❑ ❑ 14. Nutrient bottle(s) pH < 2? ❑ ❑ 18. Oil & Grease bottle(s) pH < 2? <br />❑ ❑ 15. Cyanide bottle(s) pH a 12? ❑ ❑ 19. Volatiles pH < 2? <br />❑ ❑ 16. Sulfide bottles) pH > 9? <br />COMMENTS:- 717,1� f T6& -L_ — - - <br />F:1lnoipeNo Fams%SMPIE RECEIPT CHECKUST.doc <br />❑ <br />1. <br />Shipping container In good condition? <br />❑ <br />❑ <br />2. <br />Custody sealii7t on shipping container? <br />Condition Broken <br />❑ <br />Q� <br />3. <br />Ice / Blue 1 one) present In shipping container? <br />r <br />10. Samples received within holding Ames? <br />Conlainer(a) Temp. 1. �_ 2. 3. _ 4. <br />❑ <br />11. Samples In proper container? <br />4. <br />Bottles broken and/or leaking? (Photograph broken bottles.) <br />❑ <br />❑ <br />6. <br />Custody seals on sample bottles? <br />Condition: Intact Broken Ml- <br />Yes <br />No <br />LABELING Ww <br />PRESERVATIVE <br />Yes No Mltws Yes No brl ws <br />❑ ❑ 13. Metals bottle(s) pH < 2? ❑ ❑ 17. TOC bottle(s) pH < 2? <br />❑ ❑ 14. Nutrient bottle(s) pH < 2? ❑ ❑ 18. Oil & Grease bottle(s) pH < 2? <br />❑ ❑ 15. Cyanide bottle(s) pH a 12? ❑ ❑ 19. Volatiles pH < 2? <br />❑ ❑ 16. Sulfide bottles) pH > 9? <br />COMMENTS:- 717,1� f T6& -L_ — - - <br />F:1lnoipeNo Fams%SMPIE RECEIPT CHECKUST.doc <br />❑ <br />6. Chain of custody Present? <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 Ames? <br />❑ <br />11. Samples In proper container? <br />9 <br />❑ <br />12. Sufficient sample volume for Indicated tests? <br />PRESERVATIVE <br />Yes No Mltws Yes No brl ws <br />❑ ❑ 13. Metals bottle(s) pH < 2? ❑ ❑ 17. TOC bottle(s) pH < 2? <br />❑ ❑ 14. Nutrient bottle(s) pH < 2? ❑ ❑ 18. Oil & Grease bottle(s) pH < 2? <br />❑ ❑ 15. Cyanide bottle(s) pH a 12? ❑ ❑ 19. Volatiles pH < 2? <br />❑ ❑ 16. Sulfide bottles) pH > 9? <br />COMMENTS:- 717,1� f T6& -L_ — - - <br />F:1lnoipeNo Fams%SMPIE RECEIPT CHECKUST.doc <br />