Laserfiche WebLink
DC#_Title: ENV-FRM-SHRT-0175 v00_Condition Upon Receipt Form Soils <br /> Effective Date: 10/6/2022 <br /> Survey Meter# Model 12SA; SN 136491 <br /> Thermometer SN# 27130475 <br /> Condition Upon Receipt Soils (Attach to COC) <br /> Sample Receipt <br /> 1 Number of ice chests/packages received: a. <br /> Note as"OTC"if samples are received over the counter, unpackaged <br /> 2 Were the samples received intact?(no broken bottles,leaks,etc.) No N/A <br /> 3 Were the sample custody seals intact? No N/A <br /> 4 Is the COC properly completed, legible, and signed? No <br /> 5 Emission rate of samples for radiochemical analyses<0.5mR/hr? Ca> No N/A <br /> 6 COC Number(If applicable): <br /> 7 Does the workorder contain organics? Yes V N/A <br /> If Yes: Temps Observed(°C): <br /> Temps Corrected(°C): <br /> Received on ice? Yes ®° <br /> Received in holding? Yes No <br /> Received in method prescribed containers? Yes No <br /> 8 Do the number of samples agree with the COC? 449 No N/A <br /> Sample Verification, Labeling &Distrjbution 4 <<{s IfJt, J' p <br /> 1 Were all requested analyses understood and appropriate? No <br /> 2 Did the sample labels correspond with the COC information? No <br /> 3 Specially requested detection limits(RLs)assigned? Yes No <br /> 4 Have rush or project due dates been checked and accepted? Yesd��•'1Nk <br /> 5 Do samples require subcontracted analyses? Yes <br /> If"Yes", which type of subcontracting is required? General Customer-Specified Certified <br /> Sample Receipt, Verification, Login, Labeling&Distribution completed by(initials): 91 r <br /> Set ID: J�y°ad(.? <br /> Discrepancy !• ii -i • . (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: 109293 Pace®Analytical Services, LLC Page 1 of 1 <br />