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ALS ENVIRONMENTAL <br />Sample Receiving Checklist <br />Client: tqn JgJA ALS Job #: <br />Project: g jb, f I L10 3 `O 010 a 12_ <br />Received Date: 'S'11.507 <br />Type of shipping container: <br />Shipped via: FedEx Ground <br />FedEx Express <br />Received Time:. (1: 51b 11YO By: <br />Cooler \, Box Other <br />UPS Mail Courier Hand Delivered <br />Yes <br />Were custody seals on outside of shipping container? <br />J <br />If yes, how many? 1 Where? b <br />Custody seal date: 3/ijil Seal name: Sean 6,"er <br />Was Chain of Custody properly filled out (ink, signed, dated, etc.)? <br />D( <br />Did all bottles have labels? <br />Did all bottle labels and tags agree with Chain of Custody? <br />Were samples received within hold time? <br />Did all bottles arrive in good condition (unbroken, etc.)? <br />Was sufficient amount of sample sent for the tests indicated? <br />Was correct preservation added to samples? <br />J� <br />If no, Sample Control added preservative to the following: <br />Sample Number Reagent Analyte <br />No N/A <br />Were VOA vials checked for absence of air bubbles? <br />Bubbles present in sample #: <br />Temperature of cooler upon receipt:i OPI icy. Col Cool Ambient N/A <br />Explain any discrepancies: <br />Was client contacted? Who was called? By whom? Date: <br />Outcome of call: <br />X <br />