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KI FF RECEIVER Analvtical uc SAMPLE RECEIPT CHECKLIST E SRG#: 5 2 Date: v Z�./� Project ID: l e 6 D r i7 *OG k�0,1 L e rQ / Method of Receipt: ❑Courier ver-the-counter ❑Shipper FEB 16 2016 Shipping Only: ❑FedEx• ❑OnTrac 0 ❑G yhound ❑Other 'Service level if not Priority or Sunrise(M-F): A COC Inspection ENVIRONM' „L Is COC present? `` Yes ❑No HEA!TN r"FPARIVE NT Custody seals on shipping container? CC❑Intact ❑Broken ❑Not presentAN/A Is COC Signed by Relinquisher? Wyes ❑No Dated? RYes ❑No Is sampler name legibly indicated on COC? NiYes ❑No Is analysis or hold requested for all samples? Yes ❑No Is the turnaround time indicated on COC? Yes ❑No Is COC free of whiteout and uninitialed cross-outs? Yes ❑No,Whiteout ❑No,Cross-outs Sample Inspection Coolant Present: Yes No(includes water) Temperature°C I S Therm. ID# _-i�f - 3 Initial L Date/Time ��Z�/(0E]N/A Are there custody seals on sample containers? ❑Intact ❑Broken of present Do containers match COC? Wyes ❑No ❑No,COC lists absent sample(s) ❑No,Extra sam le(s)present Are there samples matrices oth6r than soil,water,air or carbon? ❑Yes ANo Are any sample containers broken,leaking or damaged? ❑Yes o Are preservatives indicated? E]Yes,on sample containers ❑Yes,on COot indicated>5N/A Are preservatives correct for analyses requested? ❑Yes ❑No Lit N/A Are samples within holding time for analyses requested? Yes ❑No Are the correct sample containers used for the analyses requested? Yes EJNo Is there sufficient sample to perform testing? Yes ❑No Does any sample contain product,have strong odor or are otherwise sAspected to be hot? ❑Yes I1Vo Receipt Details MatrixS �1/0 Container types 1_ #of containers received Matrix Container type #of containers received Matrix Container typer�7 ^^ of containers received Date and Time Sample Put into Temp Storage Date. c�910 Z Time: t 4"_0 uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) ;�tOn Both ❑Not indicated If Sample ID's are listed on both COC and containers,do they all match? Yes ❑No ❑N/A Is the Project ID indicated: On COC ❑On sample cont?iner(s) ❑On Both ❑Not indicated If project ID is listed on both COC and containers,do they all match? ❑Yes �No ON/A Are the sample collection dates indicated: F-1On COC ❑On sample container(s) On Both E]Not indicated If collection dates are listed on both COC and containers,do they all match? 1�51Yes ❑No ❑N/A Are the sample collection times indicated: ❑On COC ❑On sample container(s) _g&On Both ❑Not indicated If collection times are listed on both COC and containers,do they all match? Yes ❑No ❑N/A COMMENTS: O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 072412.doc Page 3 of 3