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. a <br /> s <br /> � ! 1 ! ane^cerv�ea <br /> J Analvtical LLC WW REcEIPT CHECKLIST V Initials <br /> SRC#: Date: 072`3O <br /> Project ID: Cox' X COX <br /> Method of Receipt: 0 Courier 0 Over-the-counter Whipper <br /> COC Insnection <br /> Is COC present? Wles ❑No <br /> Custody seals on shipping container? ❑Intact ❑Broken kNot present d N/A <br /> Is COC Signed by Relinquisher? , Yes ❑No Dated? 12yyes ❑No <br /> Is sampler name legibly indicated on COC? M Yes ❑No <br /> Is analysis or hold requested for all samples Yes ❑No <br /> Is the turnaround time indicated on COC? es ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? es []No,Whiteout ❑No,Cross-outs <br /> Samnlelnsoeelion- <br /> Coolant Present: Yes No includes water) <br /> Temperature OC 0.0 Therm. ID# ph InitialL-Gy?_ Date/Time D7290V ❑N/A <br /> Are there custody seals on sample containers? ❑Intact - ❑Broken Mot present <br /> Do containers match COC? ( Yes []No ❑No,COC lists absent sample(s) ❑No,Extra sample(s)present <br /> Are there samples matrices other than soil,water,air or carbon? ❑Yes CRJVo f <br /> Are any sample containers broken, leaking or damaged? ❑Yes BNO <br /> Are preservatives indicated? ❑Yes,on sample containers ❑Yes,on COC ❑Not indicated ®N/A <br /> Are preservatives correct for analyses requested? ❑Yes ❑No MWA k <br /> Are samples within holding time for analyses requested? es ❑No <br /> Are the correct sample containers used for the analyses requested? Yes ❑No <br /> Is there sufficient sample to perform testing? Yes ❑No I` <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes ErNo <br /> Receipt Details <br /> Matrix S Container type Joteve #of containers received: Z <br /> Matrix Container'type #of containers received <br /> Mahix Container type #of containersrecei'vd <br /> Date and Time Sample Put into Temp Storage Date: 072q,02 Time: <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) n Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? �( ❑No EJ N/A <br /> Is the Project ID indicated: On COC ❑On sample container(s) r �"Both E]Not indicated <br /> If project ID is listed on both COC and containers,do they all match? es ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample containers) n Both [-]Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? J e ❑N/A <br /> Are the sample collection times indicated: ❑On COC p On sample container s) No n Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? es ❑No ❑N/A <br /> COMMENTS: i <br /> 1 <br /> i <br /> i <br /> f <br /> I <br /> O:lold ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br />