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Para;on Analv[ics - Forc Collins, Colorado `', <br />- ~ ~ CONDITION OF SA:~~LE UPON RECEIPT <br />CLIENT: ~ a~. ' c~~ SHIPPING CON` TAKER m: ~~~ <br />' WORKORDERNO. %~-G3-c.'~i~ INITIAL s: ~/~ DATE: ~-lS~b <br />1. Does this project require special handling according to ~ ESA, Level 3, <br />or CLP protocols? <br />If yes, complete a. and b. <br />a. Cooler Temperature <br />b. Lot No's. <br />c. Airbill Number Yes No <br />2 .Are custody seals on the cooler intact? If so, how many N!A Yes No <br />3. ,Are custody seals on sample containers intact? i Yes No <br />4. Is there a Chain of Custody (COC) or other representative documents, <br />letters or shipping memos? ~s No <br />~. Is the COC complete? <br />Relinquished: Yes ~o Requested Analysis: Yes ~ No_ ~-~ No <br />b. Is the COC in agreement with the samples received? <br />No. of Samples: Yes^~'iVo Sample ID's: Yes ~No <br />iV(atri~c: Yes~No_ No. of Containers: Yes ~o `;~ No <br />7. Are the samples preserved correctly? (~i IJA Yea No <br />3. Is there enough sample'? If so, aze they in the proper containers? ~:s No <br />9. Are all samples within holding times for the requested analyses? ~3i No <br />10. Were the sample received on ice? N/A Yrs ~o~ <br />11. Were all sample containers received intact? (not broken or leaking, etc.) No <br />12. Are samples requiring no headspace, headspace free? N/A ~ Yf:s ~ No <br />13. Do the samples require quarantine'? Yes t o <br />1~. Do samples require ATI disposal? e~ No <br />1~. Did the client return any unused bottles? Yes <br />Describe "NO" items (e:ccept No's i, 13, &14): <br /> <br /> <br />Was the client contacted? Yes '~C No <br />If yes, Date: ; /S/u ~ Name of person contacted: ~~U:~r tea-, <br />Describe actions taken or client instructions: l'~ ~~ 1 ~.- a >s ~ ~ o~ o / s,' s bP <br /> <br /> <br />Group Leader's Signature: x Date: ~- 5' 6 <br />CoolerTemperanue: /~ `~ <br />ATI FRM ZOIFCS (2/21/96) <br />