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ALS Environmental-Fort Collins • <br /> CONDITION OF SAMPLE UPON RECEIPT FORM <br /> A <br /> Client: _01. r Workorder No: \ \. Z'3 \ <br /> Project Manager: --S-V--\-C— Initials:_ ''.�� Date: v o `,�v _1/4..... c-‘,. <br /> I. Are airbills/shipping documents present and/or removable? DROP o�F YES NO <br /> 2. Are custody seals on shipping containers intact? elra YES NO <br /> 3. Are custody seals on sample containers intact? (10 I YES NO* <br /> 4. Is there a COC(chain-of-custody)present? IYES� NO <br /> Is the COC in agreement with samples received? (IDs,dates,times,#of samples,#of containers, NO <br /> s. matrix,requested analyses,etc.) <br /> 6. Are short-hold samples present? YES 0) <br /> 7. Are all samples within holding times for the requested analyses? AZ NO* <br /> 8. Were all sample containers received intact? (not broken or leaking) NO* <br /> 9. Is there sufficient sample for the requested analyses? NO* <br /> i0. Are all samples in the proper containers for the requested analyses? CI NO* <br /> 1 I. Are all aqueous samples preserved correctly,if required?(excluding volatiles) N/A I NO* <br /> 12 Are all samples requiring no headspace(VOC,GRO,RSK/MEE,radon)free of bubbles <br /> >6 mm(1/4 inch)diameter?(i.e.size of green pea) 41 YES NO <br /> 13. Were the samples shipped on ice? �YF) NO <br /> 14• Were cooler temperatures measured at 0.1-6.0°C? r „�:. #1 (#- #4 I • ONLY YES 41111L <br /> Cooler#: 1 • <br /> Temperature(°C): l -to <br /> No.of custody seals on cooler: <br /> DOT Surwyl <br /> Acesplancit ExternalµR/hr reading: <br /> infognuson <br /> BackgroundµR/hr reading: `3 <br /> Were externalµR/hr readings S two times background and within DOT acceptance criteria? YES/NO :MO(If no,see Form 008.) <br /> *Please provide details here for NO responses to gray boxes above-for 2 thru 5&7 thru 12,notify PM&continue w/login. <br /> All client bottle ID's vs ALS lab ID's double-checked by: <br /> If applicable,was the client contacted?YES/NO/jei Contact: Date/time: <br /> Project Manager Signature/Date: r /o'IV't f <br /> Form 201r28.xls *IR Gun #1,VWR SN 170560549 <br /> 00/07/2019) *IR Gun#3,VWR SN 170647571 f11 of 59 <br /> *1R Gun#4,Oakton,SN 2372220101-0002 Page 1 o <br />