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KIFFt = <br /> SAMPLE RECEIPT CHECKLIST Analytical uc <br /> SRG #: O 03S TAT: Standard Rush Fj Split None <br /> Sample Receipt I Initials/Date: -rT6 497 J 3; 1 Storage Time: I Sam le Login I Initials/Date: <br /> Method of Receipt: RCourier Over-the-counter El Shipped Sig Custody Seals N/A Intact F1 Broken <br /> Tem °C 3,2 N/A Therm ID:reβ€”( Time !3q0 Coolant resent gj Yes F1 No Water I Temp Excursion <br /> Chain-of-Custody: Yes No Documented on COC Labels Discrepancies: <br /> Is COC resent? X Sample ID / / <br /> Is COC signed by relin uisher? x Project ID /10 <br /> Is COC dated by relin uisher? Sample Date <br /> Is the sampler's name on the COC? Sample Time <br /> Are there analyses or hold for all samples? K Does COC match project history? N/A 1 Yes No <br /> Samples: NIA Yes No Comments: f7 j l ryb <br /> Are sample custody seals intact? <br /> Are sample containers intact? X <br /> Is preservation documented? 7< <br /> In-house Analysis: N/A Yes No <br /> Are preservatives acceptable? <br /> Are samples within holding time? <br /> Are sample container types correct? <br /> Is there adequate sample volume? X <br /> Receipt Details: <br /> Matrix Container Type #of Containers <br /> CS Required: <br /> Proceed With Analysis: ❑ YES ❑ NO Init/Date- <br /> CD Client Communication: <br /> 0 <br /> O:bW edtsampreclFormsl Sample Receipt Checidist W13 rmh <br />