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lel FF R'EcEEEIIVEERR <br /> Analvtical llc SAMPLE RECEIPT CHECKLIST Initials <br /> SRG#: _F4 -q( Date: eeloet o <br /> Project ID: /V2 5710,- 6-'k <br /> Method of Receipt: F Courier D Over-the-counter Shipper <br /> COC Inspection <br /> Is COC present? ®,Yes ❑No <br /> Custody seals on shipping container? ,S Intact ❑Broken ❑Not present ❑N/A <br /> Is COC Signed by Relinquisher? 91 Yes ❑No Dated? N Yes ❑No <br /> Is sampler name legibly indicated on COC? ❑Yes RJNo <br /> Is analysis or hold requested for all samples Yes ❑No <br /> Is the turnaround time indicated on COC? Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? R Yes ❑No,Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: Yes ❑No(includes water',.7� <br /> o�v��0 jU S E]N/A <br /> Temperature°C 3.6 Therm.ID# J �L—5 Initial Date/Time <br /> Are there custody seals on sample containers? ❑Intact ❑Broken 9 Not present <br /> Do containers match COC? &Yes ❑]io []No,COC lists absent sample(s) ❑No,Extra sample(s)present <br /> Are there samples matrices other than soil,water,air or carbon? ❑Yes WNO <br /> Are any sample containers broken, leaking or damaged? ❑Yes No <br /> Are preservatives indicated? E�Yes,on sample containers ❑Yes,on COC [:]Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? Yes ❑No ❑N/A <br /> Are samples within holding time for analyses requested? Yes ❑No <br /> Are the correct sample containers used for the analyses requested? Yes ❑No <br /> Is there sufficient sample to perform testing? Wes ❑No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes X No <br /> Receipt Details <br /> Matrix_ Container type \10A #of containers received 5 <br /> Matrix Container type #of containers received <br /> Matrix Container type #of containers received <br /> Date and Time Sample Put into Temp Storage Date: d q dg l o Time: 10 <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? 0 Yes []No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? ZKYes 11 No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? CYes No E]N/A <br /> Are the sample collection times indicated: E]On COC ❑On sample contamer(s) On Both El Not indicated <br /> If collection times are listed on both COC and containers,do they all match? 9-Yes No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 9 of 10 Page 8 of 8 <br />