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KIFFO RC sr� Analvtical uc SAMPLE RECEIPT CHECKLIST !, initials SRG#: _7Z-g�� Date: Q��I C� �lI V Project ID: i %I ✓1 �� y(kl.�r y, 7t�G% Method of Receipt 'Courier ❑ Over-the-counter ❑ Shipper 1 COC Inspection Yes [:J No Is COC present? � Intact ❑ Broken ❑ Not present 5AN/A Custody seals on shipping container? Is COC Signed by Relinquisher? X 1.Yes ❑ No Dated? Yes ❑ No Is sampler name legibly indicated on COC? ® Yes ;KYes ❑ No ❑ No Is analysis or hold requested for all samples ayes ❑ No Is the turnaround time indicated on COC? Is COC free of whiteout and uninitialed cross -outs? ❑ Yes ❑ No, Whiteout RNo, Cross -outs Sample Inspection Coolant Present: �es ❑No (includes water Q�� ❑N/A Temperature 'C q.� Therm. ID# �/e—S InitialDate/Time Are there custody seals on sample containers? ❑ Intact ❑ Broken Not present Do containers match COC? Mes ❑ No ❑ No, COC lists absent sample(s) ❑ No, Extra sample(s) present Are there samples matrices other than soil, water, air or carbon? ❑ Yes %No Are any sample containers broken, leaking or damaged? ❑ Yes No Are preservatives indicated? E] Yes, on sample containers ❑ Yes, on COC ❑ Not indicated �A Are preservatives correct for analyses requested? ❑ Yes ❑ No Are samples within holding time for analyses requested? Yes ❑ No Are the correct sample containers used for the analyses requested? 0 Yes ❑ No is there sufficient sample to perform testing? Yes ❑ No Does any sample contain product, have strong odor or are otherwise suspected to be hot? ❑ Yes J�QNo Receipt Details Matrix D Container type t'� # of containers received_ Matrix Container type # of containers received Matrix Container type ## of ontainers received Date d Time Sample Put into Temp Storage Date: `/ �� Time: an uicklo Are the Sample ID's indicated: ❑ On COC ❑ On sample container(s) On Both ❑ Not indicated If Sample ID's are listed on both COC and containers, do they all match? Yes [N No ❑ N/A Is the Project ID indicated: ❑ On COC ❑ On sample container(s) On Both ❑ Not indicated If project ID is listed on both COC and containers, do they all match? N -Yes SNo ❑ N/A Are the sample collection dates indicated: ❑ On COC ❑ On sample container(s) � n Both E] Not indicated If collection dates are listed on both COC and containers, do they all match? 2Yes ❑ No ❑ N/A Are the sample collection times indicated: ❑ On COC ❑ On sample container(s) PQ On Both ❑ Not indicated If collection times are listed on both COC and containers, do they all match? JQYes [:]No ❑ N/A COMMENTS: O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409,doc Page 13 of 13