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lel FF H RECEIVER <br /> Analvtical LLC SAMPLE CEIPT CHECKLIST <br /> Initisla <br /> f SRG#: Date: 0-22�-30 <br /> Project ID; <br /> Method of Receipt: El Courier D Over-the-counter Whipper ff <br /> COC Inspection <br /> Is COC present? n'es ❑No <br /> Custody seals on shipping container? ❑Intact ❑Broken Not present d N/A <br /> Is COC Signed by Relinquisher? , Yes ❑No Dated? tea <br /> es ❑No <br /> Is sampler name legibly indicated on COC? es E]No <br /> Is analysis or hold requested for all samples es [:]No <br /> Is the turnaround time indicated on COC? es ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? ❑No,Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: XYes No includes water) <br /> Temperature°C Q,D Therm. ID# Initial_Lf}�2 Date/Time 07��1 E]N/A 1 <br /> Are there custody seals on sample containers? <br /> ❑Intact E]Broken ENPot 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 D?,No <br /> Are any sample containers broken, leaking or damaged? ❑Yes KIN <br /> o <br /> Are preservatives indicated? ❑Yes,on sample containers ❑Yes, on COC ❑Not indicated ®N/A <br /> Are preservatives correct for analyses requested? ❑Yes ❑No 21�4/A <br /> Are samples within holding time for analyses requested? es No f <br /> Are the correct sample containers used for the analyses requested? 'Yes ❑❑No <br /> Is there sufficient sample to perform testing? Yes ❑No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes t�rNo <br /> Receipt Details <br /> Matrix SO Container type 4t e✓e #of containers received —2— <br /> Matrix <br /> Matrix Container type #of containers received <br /> Matrix Container type #of containers recei <br /> Date and Time Sample Put into Temp Storage Date: n7 2'�0`7 Time: ff <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 ❑N/A <br /> Is the Project ID indicated: E]On COC ❑On sample container(s) n Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? EFVes []NO ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) n Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? �e No ❑N/A <br /> Are the sample collection times indicated: E]On COC ❑On sample container s) Both ❑Not indicated i <br /> If collection times are listed on both COC and containers,do they all match? es ❑No ❑N/A <br /> COMMENTS: <br /> i <br /> I <br /> O:\old_ed\sarnprec:\Forms\Sarnple Receipt Checklist rev 051409.doc <br /> J <br />