COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

KIFFO RECEIVER � Analvtical uc SAPLE RECEIPT CHECKLIST Q G/ Initials SRG#: Z Date: O (� ` I Z Project ID: e 601-O _406 4O') TC r y✓//'o q Method of Receipt: ❑Courier Wver-the-counter F-1Shipper Shipping Only: ❑FedEx' ❑OnTrac' ❑Grey ound ❑Other 'Service level if not Priority or Sunrise(M-F): COC Inspection Is COC present? 1XWes ❑No Custody seals on shipping container? Uintact ❑Broken ❑Not present�N/A Is COC Signed by Relinquisher? WYes E]No Dated? Isa Yes E]No �— Is sampler name legibly indicated on OC? Yes E]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? AYes ❑No,Whiteout ❑No,Cross-outs Sample Inspection Coolant Present: Yes E]No(includes water) � Temperature°C ITherm. ID# Initial L Z Date/Time I Z�['p 3 ❑N/A Are there custody seals on sam le containers? ❑Intact ❑BrokenNot present Do containers match COC? Yes ❑No ❑No,COC lists absent sample(s) ❑No,Extra saniple(s)present Are there samples matrices of r than soil,water,air or carbon? ❑Yes No Are any sample containers broken, leaking or damaged? ❑Yes No Are preservatives indicated? ❑Yes,on sample containers ❑Yes,on COC r_1 Not indicated /A Are preservatives correct for analyses requested? ❑Yes ❑No N/A Are samples within holding time for analyses requested? Yes ❑No Are the correct sample containers used for the analyses requested? Yes ❑No Is there sufficient sample to perform testing? es ❑No Does any sample contain product,have strong odor or are otherwise sus ected to be hot? ❑Yes o Receipt Details f p Matrix lvy Container type Glee y- #of containers received O Matrix Container type #of containers received Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Date: OSyq 1 Z Time: Ouickloe 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? e ❑No ❑N/A Is the Project ID indicated: ❑On COC ❑On sample cont tner(s�On Both ❑Not indicated If project ID is listed on both COC and containers,do they all match? �'�'es ❑No ❑N/A Are the sample collection dates indicated: ❑On COC ❑On sample contafner(s)��On Both ]Not indicated If collection dates are listed on both COC and containers,do they all match? 12911'es ❑No ❑N/A Are the sample collection times indicated: ❑On COC ❑On sample container(s) POn Both ❑Not indicated If collection times are listed on both COC and containers,do they all match? Yes ❑No ❑N/A COMMENTS: n c l P VVIR HIEPTY O:\old_ed\samprec\Forrns\Sample Receipt Checklist rev 072412.doc Page 8 of 8