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ocumen arne: ocumen ewse : <br /> � aCeArrdfytiCal' Sample Condition Upon Receipt Form August 1�,2014 <br /> f ,,,,:.,.,,,.a, ocumen o. ssumg u on y: <br /> ( FFL-C-007 rev.06 Pace Florida Quaiity Office <br /> � ' • • � �• - � • Table Number� <br /> Client Name: �a;p1�(� ���S . Project# �'rJ����Og <br /> Courier: � Fed Ex ❑ UPS❑ USPS❑ Ciient ❑ Commercial t/t Pace ❑ Other <br /> T <br /> Tracking# <br /> Custody Seal on CoolerBox Present: ❑ yes � no Seals intact: �yes ❑no Date and Initials pf pe son examining <br /> contents ��+,� <br /> Packing Material: 0 Bubble Wrap �Bubble Bags �None �Other '�,+� <br /> Thertnometer Used �pJ ��� Type of Ice: Wet' Blue None <br /> Q (Temp shoWd be above freezing to 6°C). If below 0°C,then was <br /> CoolerTemperature'C 3� t� (Visual) � (CorrectionFactor) i {pctual) sampiefrozen? <br /> OYes �No <br /> Receipt of samples satisfactory: �es pNO Rush TAT requested on COC: <br /> if es,then all conditions below were met: If no,then mark box 8�describe issue use comments area if necessary): <br /> Chain of Custody Present ❑ � <br /> Chain of Custody Filled Out ❑ <br /> Relinquished Signature&Sampler Name COC ❑ <br /> Samples Arrived within Hoid Time <br /> ❑ <br /> Sufficient Volume ❑ <br /> Cbrrect Containers Used ❑ <br /> Containers Intact <br /> ❑ <br /> Sample Labels match COC(sample IDs&date/time of collection) ❑ <br /> No Labels: � No Time/Date on labels: � <br /> All containers needing preservation are found to be in � <br /> compliance with EPA recommendation. <br /> No Headspace in VOA�als(>6mm): <br /> ❑ <br /> Client Notification!Resolution: <br /> Person Contacted: Dateffime: <br /> Comments/Resolution(use back foP additional comments): <br /> Project Manager Review: Date� <br /> Finished Product Information Only <br /> F_P.samPie i�: Size&Qty of Bottles Received <br /> x 5 Gal <br /> P�oduction Code: x 2.5 Gal <br /> x 1 Gai <br /> �ate/Time Opened: x 1 Liter <br /> � x 500 mL <br /> m <br /> � Number of Unopened Bottles Remaining: x 250 mL <br /> o x bther: <br /> o Extre Sampie in Shed: Yes No <br /> i o <br /> -� -� <br />