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DC#_Title: ENV-FRM-SHRT-0033 00_Condition Upon Receipt Form Terra <br /> '- ace Lab <br /> Effective Date:05/13/2022 <br /> Survey Meter# Model 2241-2, SN 182115 <br /> pH strip lot# HC203864 <br /> Thermometer SN# 27130475 <br /> Condition Upon Receipt (Attach to COC1 <br /> Sample Receipt <br /> 1 Number of ice chests/packages received: LL ROI? Yes <br /> Note as"OTC"if samples are received over the counter,unpackaged <br /> 2 Temperature of cooler/samples. (If more than 8 coolers,please write on back <br /> Temps Observed ('C). 0"' <br /> Temps Corrected(°C): u b. <br /> Acceptable is: o.1"to 10°C for Bacteria,and 0 1'to 61C for most other water parameters Samples may not have had adequate time to cool <br /> following collection. indicate ROI(Received on Ice)for iced samples received on the same day as sampled.in addition to temperature at receipt ✓ <br /> Of <br /> Client contact for temperatures outside method criteria must be documented below. 4 4,j �`A <br /> 3 Emission rate of samples for radloch c pal <br /> analyses< 0.5mR/hr? e�s No NIA ✓°���� <br /> 4 COC Number(If applicable) q 1� �/1 <br /> 5 Do the number of bottles agree with the COC? N/A <br /> s <br /> 6 Were the samples received intact? (no broken bottles.leaks, etc.) N/A <br /> 7 Were the sample custody seals Intact? �3 Yes No ''PAP�'C 0J <br /> 8 Is the COC properly completed, legible, and signed? �s^�PG r�Pj� tt. l'(,��,/V/I�/ <br /> Sample Verification Labelina&Distri4 tip ion �C�LP'.�cL D:f�.�r��,,, s n —gal <br /> 1 Were all requested analyses understood and appropriate? 6 NO cbL v, (qk tffeL <br /> 2 Did the bottle labels correspond with the COC information? �`f Yes / <br /> 3 Samples collected in method-prescribed containers? /g/�� ° -4I,1J ,3 c e`�� 1tM�!E� <br /> 4 Sample Preservation —Doi <br /> H at Receipt: Final pH (if added In lab): Preservative/Lot# Date/Time Added: �liJtti(r <br /> o t lI� <br /> " 7 "s_otat Metals /4"/Total Metals HNO, �r" �� J�At <br /> Doss Metals Diss Metals HNC; F ared and prase ed oil metals 'Jh <br /> Nutrient ^� ��-•� Nutrient HMSO, �'/e t)t. 0 <br /> �ul„r•- ()'t� '�< MV`�f+Ptt Ln�lYil <br /> Cyanide Cyanide NaOH C 1- <br /> Sulfide Sulfide ZnAcet <br /> Phenol Phenol H,SO, <br /> SDWA Rads SDWA Rads HNO3 <br /> 5 VOA vials have<6mm headspace? Yes No PST <br /> 6 Were all analyses within holding time at the time of receipt? M No <br /> 7 Have rush or project due dates been checked and accepted? Yes No <br /> 8 Do samples require subcontracted analyses? Yes <br /> If"Yes", which type of subcontracting is required? General Customer-Spe�ified Certified <br /> Sample Receipt, Verification, Login, Labeling & Distribution completed by(initials)' _ fA3oa lot <br /> Set ID: <br /> Discrepancy Documentation (use back of sheet for notes on discrepancies) <br /> Any items listed above with a response of"No"or do not meet specifications must be resolved. <br /> Person Contacted: Method of Contact: _Phone' <br /> Initiated By: Date/Time _ Email: <br /> Problem- <br /> Resolution: <br /> Qualtrax ID: 70962 Page 1 of 1 <br />