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=201[r'1..0 <br />SAMPLE RECEIPT CHECKLIST <br />Company Name0-41Y C& ._. DaWl-ime Received _(��1.7— /40 C1 Y5 <br />Data ! T me <br />Project �,p..4a.�_ Received bye <br />Lab Numbers) 701—?0to I f— D Carrier Name WV5 <br />Yes No UNPACKING Initials <br />❑ 1. Shipping container in good condition? <br />❑ 2. Custody sealsimmnt on shipping container? <br />Condition: nt Broken <br />❑ 3. Ice / Ellue Ice (circle one) present In shipping container? <br />Container(s) Temp. 1. LtA 2. m ; 1 3. 4. <br />❑ 4. Bottles broken and/or leaking? (Photograph broken bottles.) <br />❑ 5. Custody on sample le bottles? <br />P <br />Condition: Intact Broken <br />Yes No LABELING Initials <br />PRESERVATIVE <br />Yes No Inluds Yes No In1W9 <br />❑ ❑ 13. Metals bottle(s) pH < 2? ❑ ❑ 17. TOC bottle(s) pH < 2? <br />❑ ❑ 14. Nutrient bottle(s) pH < 2? ❑ ❑ 18. ON & Grease battles) pH < 2? <br />❑ ❑ 15. Cyanide bMe(s) pH > 12? ❑ ❑ 19. Volatiles pH < 2? <br />❑ ❑ 16. Sulfide bottle(s) pH > 9? <br />COMMENTS: <br />F-Mmugadc Fom a%SAMPM RFCEIPT CHECKUST.doc <br />[3 <br />ti. Chain of custody Present? <br />rY <br />❑ <br />7. Chain of custody includes signatures, dates, and times when relinquished and received? <br />❑ <br />B. Chain of custody agneas 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 />di <br />❑ <br />12. Sufficient sample volume for Ind cated tests'? <br />PRESERVATIVE <br />Yes No Inluds Yes No In1W9 <br />❑ ❑ 13. Metals bottle(s) pH < 2? ❑ ❑ 17. TOC bottle(s) pH < 2? <br />❑ ❑ 14. Nutrient bottle(s) pH < 2? ❑ ❑ 18. ON & Grease battles) pH < 2? <br />❑ ❑ 15. Cyanide bMe(s) pH > 12? ❑ ❑ 19. Volatiles pH < 2? <br />❑ ❑ 16. Sulfide bottle(s) pH > 9? <br />COMMENTS: <br />F-Mmugadc Fom a%SAMPM RFCEIPT CHECKUST.doc <br />