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KIFFO RECEIVER Analvticai icCSAMPLE RECEIPT CHECKLIST 1n;t;als SRG##: 5,q,6 co Date: 1122-10 J! K Project ID: _ 5!N'L p1a- Method of Receipt: Courier Over-the-counter Shipper COC Inspection Is COC present? Yes ❑No Custody seals on shipping container? ❑Intact ❑Broken ❑Not present SN/A is COC Signed by Relinquisher? KYes ❑No Dated? ®,Yes ❑No Is sampler name legibly indicated on COC? g Yes ❑No Is analysis or hold requested for all samples MCS ❑No Is the turnaround time indicated on COC? M Yes ❑No Is COC free of whiteout and uninitiated cross-outs? Ryes ❑No,Whiteout ❑No,Cross-outs Sample Inspection Coolant Present: KYes ❑No(includes wa1 Temperature OC 14,f Therm.ID#_ ;=g-2— Initial J V Date/Time Z Z t OL, �� ❑N/A Are there custody seals on sample containers? ❑Intact ❑Broken Not present Do containers match COG? [K Yes ❑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? ❑YesNo Are preservatives indicated? L]Yes,on sample containers ❑Yes,on COC Not indicated E N/A Are preservatives correct for analyses requested? ❑Yes ❑No NIA 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? Yes ❑No Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes ,®No Receipt Details Matrix Container type�� • - #of containers received_ Matrix Container typeJLj2kdk(y) #of containers received— Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Date. l ZZ I Q Time: uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) �bi n Both ❑Not indicated If Sample ID's are listed on both COC and containers,do they all match? es ❑No ❑NIA It Is the Project ID indicated: ❑On COC ❑On sample containers) On Both C]Not indicated If project ID is listed on both COC and containers,do they all match? es No ❑NIA Are the sample collection dates indicated: ❑On COC ❑On sample conNingr(s) >EZ r(s) n Both ❑Not indicated If collection dates are listed on both COC and containers,do they all match? Yes �o E]N/A Are the sample collection times indicated: L]On COC ❑On sample conOn BothE]Not indicated If collection times are listed on both COC and containers,do they all match? Yes ❑No ❑N/A COMMENTS: I Oaold_edlsampreclFormslSample Receipt Checklist rev 051409.dm Page 4 of 4