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woo no~.+~niu a;K <br />s~ M-~ sa+~a co tan <br /> <br />SAMPLE RECEIPT FORM <br />CLIENT: ~~ °'`v.2 <br />PROTECT#: L~~/'G~`/ Page 1 of 2 <br /> <br />DATE ~ O 6 <br />1) Doe this project require special handling procedure such as CLP protocol? ~ YES NO <br />2) Are the ctutody seals on the cooler intact? NA NO <br />3) Arc the custody seals on the sample containers intact? YES NO <br />1) Is there a Chain of Custody (COC), or other directive shipping papers present? NO <br />S) Is the COC rnmplete? <br />Relinquished? Yes No Requested Analysis? Yes _ <br />No _ ~!~' NO <br />6) Is the COC in agreement with the samples received? <br /># oC Samples: Yes _ No _ Sample m: Yes _ <br />Matrix: Yes No #oCContainers: Yes <br />No <br />No NO <br />7) Is there enough sample for all requested analysis? NO <br />8) Are all samples within holding times Cor requested analysis? NO <br />9) Were all sample containers received intact? NO <br />IO) Are samples requiring no headspatt, headspatt hee? NA YES NO <br />11) Do the samples require a Foriegn Soils Permit Label or quarantine? YES -~ <br />12) Do samples require special disposaVhold considerations? <br />Non-Hazardous: Yes No Hazardous: Yes No <br />Hold: months <br />Describe "NO' items (except # 1, l 1, & 12): <br /> <br /> <br />Was the client contacted? Yes No _ <br />If .ca. Date: Name of person contacted: <br />Actions taken or client instructions: <br /> <br /> <br />Signarure: <br />F1tMQA0l I.01.99.0~ <br />