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'FF RECEIVER Analvticai t.ic 0 SAMPLE RECYIPT CHECKLIST SRG#: q ++ Date: Project ID: Lod Gt J wf e_ 0-c Method of Receipt: Courier Over-the-counter Shipper COC Inspection Is COG present? Yes ❑No Custody seals on shipping container? Intact ❑Broken ❑Not present IJV/A Is COC Signed by Relinquisher? KYes ❑No Dated? Yes ❑No Is sampler name legibly indicated on COC? Rg Yes ❑No Is analysis or hold requested for all samples Yes ❑No Is the turnaround time indicated on COC? Ryes ❑No Is COC free of whitcout and uninitiated cross-outs? ❑Yes []No, Whiteout Z No,Cross-outs Sample Inspection Coolant Present: C&YcsNo(includes water Temperature°C _Therm.ID# J79— Z Initial 777PF2 Datenime ❑N/A Are there custody seals on sample containers? . ❑Intact ❑Broke6 2SNot present Do containers match COC? []Yes 14 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? ❑Yes J�No Are preservatives indicated? �IYcs,on sample containers ❑Yes,on CDC ❑Not indicated 0 N/A } Are preservatives correct for analyses requested? f Yes ❑No ❑N/A Are samples within holding time for analyses requested? g)Yes ❑No Are the correct sample containers used for the analyses requested? [RYes [J 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 X No Receipt Details p� Matrix LA A Container type 1'�(LSLO� � #of containers received_ Matrix 1,.. K Container type 2 SO Al IJV #i of containers received__ Matrix Container type ##of containers received Date and Time Sample Put into Temp Storage Date: O 7'1 I{[Z Time: uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) A_&J On Both []Not indicated If Sample ID's arc listed on both CQC and containers,do they all match? s ❑No ❑NIA Is the Project ID indicated: On COC E]On sample containers) Vbn Both p Not indicated If project ID is listed on both COC and containers,do they all match? UYes o ❑NIA Are the sample collection dates indicated: ❑On COC ❑On same a container(s) ,ROn Both [❑Not indicated If collection dates are listed on both COC and containers,do they all match? J9Yes ❑No ❑NIA Are the sample collection times indicated: ❑On COC ❑On sample container(s) JE On Both ❑Not indicated If collection times are listed on both COC and containers,do they all match? N Yes!r ❑No ❑N/A COMMENTS: 1'W5' �A U6 VA 1 �I S N4 S O t lvd - oz jS o•, 2 j !bZ 1 O:,old c&,sampreclFormslSample Receipt Checklist rev 051409.dm Page 7 of 7