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To. DRMS Den Page 10 of 10 2017-12-08 2231.10(GMT) 13032008630 From. Greg Lewicki <br /> SAMPLE RECEIPT/CHAIN-OF -CUSTODY CHECKLIST <br /> The following items were checked for completeness,correctness,and compliance to project specifications using the <br /> Chain-of-Custody(COC)and other supporting information. <br /> Date of acceptance:II/kin By: 0 "-) <br /> SVL Work No: x01 (-)q0 <br /> Item Description V YC NV NA Comments <br /> 1 Client or project name e 1 a f CC- -1..cml.e,4 f'o 2 Date and time of receipt at lab ✓ ,t r�l t� 154.5 <br /> 9 Received by f <br /> 4 Temperature blank or cooler <br /> temperature ` 1 r r/ Temp. `C. <br /> 5 Were the sample(s)received an <br /> ice '• <br /> 6 Custody tapelbottle seals <br /> 7 Condition of samples upon receipt <br /> (leaking;bubbles In VOA vials v-*". Q 0 001 <br /> 8 Sample numbers/CDs agree with <br /> COC �+ �,, <br /> � -04k R'_- l?3.�1R.—� 102C1c"24-_._ <br /> 9 Sample date&time agree with <br /> CDC _ -#teak CvrY\ Sim t_ (0-61 <br /> 10 Number of containers for each <br /> sample <br /> 11 The correct preservative for the <br /> analysis requested <br /> 12 Did an SVL employee preserve <br /> sample(s)upon receipt <br /> 13 ' Type of oontainer for each sample <br /> f volume received ✓ <br /> 14 Analysis requested for each <br /> sample jR1 <br /> I� <br /> 15 Sample matrix description c� r — <br /> 18 GOC properly completed&legible Lx{�L1 <br /> 17 Corrections properly made(initials <br /> &date) <br /> 18 Additional comments or records of <br /> sample coigstition or treatment ' <br /> (unlisted or missing samples at <br /> laboratory,aliquot taken,sample <br /> hold,samples subcontracted, <br /> communications between client �� �Lp <br /> and laboratory) r - <br /> --19 Shipper's air bill <br /> UUslfS _gS65912-313%£s7 (v )40(12- 9z <br /> V-Verified VC-Verified Corrections Made NV-Not Verified NA-Not Applicable <br /> Additional Comments: W2- Di106 <br /> Se—r - t uP L',1V; X-1 Ol074 <br /> �\O Rus A- <br /> ttnd ))d <br /> �as4- -k 'ra\s <br />