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s KFF RECEIVER J Analytical icc SAMPLE RE IPT CHECKLIST ini SRG#: q3 I Date: 0 Project ID: Cof c" rMt G �l Method of Receipt: Courier Over-the-counter Shipper COC inspection Is COC present? U Yes [—]No Custody seals on shipping container? Intact ❑Broken ❑Not present (FN/A Is COC Signed by Relinquisher? KYes ❑No Dated? N Yes ❑No i Is sampler name legibly indicated on COC? Yes ❑No Is analysis or hold requested for all samples Yes ❑No Is the turnaround time indicated on COC? Yes ❑No Is COC free of whiteout and uninitialed cross-outs? ❑Yes []No,Whiteout nNo,Cross-outs Sample Inspection Coolant Present: ZYes No(includes water) Temperature°Cf1, !� _Therm.ID# JT— ',2 Initial J Date/Ti ❑NIA Are there custody seals on sample containers? ❑Intact ❑Brok Not present Do containers match GOC? ❑Yes Q No []No,COC lists absent sample(s) ❑No,Extra sample(s)present l Are there samples matrices other than soil,water,air or carbon? ❑Yes .R No j Are any sample containers broken,leaking or damaged? ❑Yes ZNo Are preservatives indicated? 01Yes,on sample containers ❑Yes,on COC []Not indicated ❑NIA Are preservatives correct for analyses requested? Yes ❑No ❑NIA Are samples within holding time for analyses requested? 2 Yes ❑No j Are the correct sample containers used for the analyses requested? ®,Yes ❑No Is there sufficient sample to perform testing? IQ Yes ❑No Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes No Receipt Detai Is p' -� Matrix W A Container type Pq L51.01 kkA #of containers received Matrixes Container type Z�D NP� (�b1y/ #of containers received Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Date: 011 Z 1 C7 Time: oq SZ nicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) ,Q On Both ❑Not indicated If Sample ID's are listed on both C C and containers,do they all match? s 0 No E]N/A Is the Project 1D indicated: M ]On COC ❑On sample containers) On Both L]Not indicated If project ID is listed on both COC and containers,do they all match? es o ❑NIA Are the sample collection dates indicated: ❑On COC ❑On same a container(s) JROn Both ❑Not indicated If collection dates are listed on both COC and containers,do they all match? J'Yes ❑No ❑NIA Are the sample collection times indicated: ❑On COC ❑On sample container(s) )M On Both ❑Not indicated If collection times are listed on both COC and containers,do they all match? C@ Yes.i EJ No [:]NIA COMMENTS: Per [OW 5, aJA VCJA til"tS al`s Alli,ST0 - l0Pe52/Y"?-6 . 7yrb Y12- 1O XAC23 D.%4- Jra"r ftw n�02- is can f &11. Alf" lip«z i O:lold eftamprec\Forms\S=ple Receipt Checklist rev 05 f 409.doc i Page 7 of 7 J