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ALS Environmental-Fort Collins <br /> CONDITION OF SAMPLE UPON RECEIPT FORM <br /> ALS <br /> Client:Telesto Workorder No: 2004314 <br /> Project Manager: JRK Initials:TM Date:4/28/20 <br /> 1_ Are airbills/shipping documents present and/or removable? DROP OFF ES NO <br /> z. Are custody seals on shipping containers intact? ✓ NONE YES 0* <br /> 3. Are custody seals on sample containers intact? �/ NONE YES YO* <br /> a• Is there a COC(chain-of-custody)present? ✓ ES YO* <br /> S. Is the COC in agreement with samples received? (IDs,dates,times,#of samples,#of ✓ YES 0* <br /> containers,matrix,requested analyses,etc.) <br /> e. Are short-hold samples present? YES NO <br /> 7. Are all samples within holding times for the requested analyses? ✓ YES O <br /> a. Were all sample containers received intact? (not broken or leaking) ES 0* <br /> 9. Is there sufficient sample for the requested analyses? ✓ YES O <br /> to. Are samples in proper containers for requested analyses?(form 250,sample Handling GuideliJ__ I✓ YES O* <br /> 11. Are all aqueous samples preserved correctly, if required?(excluding volatiles) YES ✓ NO* <br /> 12 Are all samples requiring no headspace(VOC,GRO, RSK/MEE, radon)free of bubbles> N/A YES NO <br /> 6 mm(1/4 inch)diameter?(i.e.size of green pea) �/ <br /> 13. Were the samples shipped on ice? �/ YES NO <br /> 14. c ? Is RADONLY YES NO <br /> Were cooler temperatures measured at 0.1 6.0 C. used': �#3 �#S ✓ <br /> Cooler#: 1 <br /> Temperature(°C): 5.4 <br /> #of custody seals on cooler: 0 <br /> External mR/hr reading: - <br /> Background mR/hrreading: 12 <br /> Were external mR/hr readin s 5 two times background and within DOT acceptance criteria? YES/NO NA If no,see Form 008.) <br /> •Please provide details here for NO responses to gray boxes above-for 2 thru S&7 thru 12,notify PM&continue w/login. <br /> 11.) 314-3-4 read initial pH of 6: added 1.0ml- NaOH (lot# RG200116-1)to achieve pH >12 <br /> Were unpreserved bottles pH checke ES/NA O All client bottle ID's vs ALS lab ID's double-checked b � <br /> If applicable,was the client contacted?YES/NO/ Contact: Date/Time: <br /> Project Manager Signature/Date: 4` >r"4 <br /> Form 201r29.xls •IR un#3,VWR SN 170647571 <br /> (10/15/2019) *IR Gun#5,VWR SN 192272629 <br /> Page 1 of <br /> 8 of 39 <br />