Laserfiche WebLink
FF RECEIVER <br /> �<1 <br /> AnalVdCal LLc 0 SAMPLE RECEIPT CHECKLIST Initials <br /> SRG#: i Date:'V <br /> Project ID: <br /> Method of Receipt: Courier Over-the-counter 292ipper <br /> COC Inspection <br /> Is COC present? Yes [:]No <br /> Custody seals on shipping container? ntact ❑Broken ❑Not present ❑N/A <br /> Is COC Signed by Relinquisher? es ❑No Dated? Wyes ❑No <br /> Is sampler name legibly indicated on OC? Yeso <br /> Is analysis or hold requested for all samples Yes �o <br /> Is the turnaround time indicated on COC? Yes F1No <br /> Is COC free of whiteout and uninitialed cross-outs? Yes ❑No,Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: Yes E]N (includes water) <br /> Temperature'C2, Therm.ID# r Initial -Date/Time0 72 /o// ?3 ❑N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken Wot present <br /> Do containers match COC? %Yes ❑No ❑No, COC lists absent sample(s) ❑No, Extra sam ]e(s)present <br /> Are there samples matrices other than soil, water,air or carbon? ❑Yes TRJNo <br /> Are any sample containers broken,leaking or damaged? ❑Yes No <br /> Are preservatives indicated? es,on sample containers ❑Yes,on COC RNot indicated ❑N/A <br /> Are preservatives correct for analys s 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? Yes []No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes No <br /> Receipt etails l <br /> Matrix Container type V P l-7 #of containers received � l <br /> Matrix Container type #of containers received <br /> Matrix Container type #of containers received <br /> Date and Time Sample Put into Temp Storage Date: 00 9 2y ( Oo Time: 1 2� <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) f 40n Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? es /❑No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) WWn Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? vyes UNo ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sairiple container(s) VOn Both []Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? ` Yes PNo ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample conta#ner(s) On Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? es ❑No ❑N/A <br /> COMMENTS: <br /> 0:1old_ed\samprec\Forms\Sample Receipt Checklist rev 051409,doc <br /> Page 12 of 13 Page 11 of 11 <br />