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K1FF O <br /> AnaMicaluc SAMPLE RECEIPT CHECKLIST SRG#: 7 <br /> Sample Receipt I Initials/Date: r ,�' I Storage Time: Sample Login Initials/Date: 25iS1 <br /> TAT: Standard Rush S fit 0 None Method of Receipt: I Z CourierOver-the-counterF Shipped <br /> Tem °C 3,G NIA Therm ID [R" Time //1 -7 Coolant resent Yes No WaterEl Temp Excursion <br /> For Shipments Only: Cooler Receipt Initials/Datefrime: Custody Seals NIA Intact Broken <br /> Chain-of-Custody: Yes No Documented on COC Labels Discrepancies: <br /> Is COC resent? l Sample ID <br /> Is COC signed by refin wisher? Project ID <br /> Is COC dated by relin uisher? ample Date <br /> Is the sam lees name on the COC? Sample Time <br /> Are there analyses or hold for all samples? Does COC match project history? WNIA Yes Fj No <br /> Samples: NIA Yes No Comments: <br /> Are sample custody seals intact? <br /> Are sample containers intact? <br /> Is preservation documented? <br /> In-house Analysis: NIA Yes No <br /> Are preservatives acceptable? <br /> Are samples within holding time? <br /> Are sample container types correct? <br /> Is there-adequate sample volume? <br /> Receipt Details: <br /> Matrix Container Type #of Containers <br /> d <br /> CS Required: <br /> Proceed With Analysis: ❑ YES ❑ NO Init/Date: <br /> CD Client Communication: <br /> co <br /> 0 <br /> 00 <br /> Wold edlsampreclFormslSample Receipt Checklist rev 070113.doc <br />