Laserfiche WebLink
K'FF RECEIVER <br /> Analvtical Lac SAMPLE RECEIPT CHECKLIST <br /> Initials <br /> SRG#: 7Z4-31 D Date: n2-8-16 <br /> Project ID: i�1 e'5( Le - 40ap \' <br /> Method of Receipt: Courier Over-the-counter Eg-Shipper <br /> COC Inspection <br /> Is COC present? g Yes ❑No <br /> Custody seals on shipping container? ®-Intact ❑Broken ❑Not present ❑N/A <br /> Is COC Signed by Relinquisher? ' 4Yes ❑No Dated? SlYes ❑No <br /> Is sampler name legibly indicated on COC? ❑Yes PSNo <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? 9yes ❑No,Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: 2rYes ❑No(includes water) ff <br /> Temperature'C 6,Q Therm. ID# .L P_-� Initial IMAs Date/Time 07 �-8"/U/6�0 ❑N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken ZNot present <br /> Do containers match COC? TgYes ❑No ❑No,COC lists absent sample(s) ❑No,Extra sample(s)present <br /> Are there samples matrices other than soil,water,air or carbon? ❑Yes J�j[No <br /> Are any sample containers broken, leaking or damaged? ❑Yes E f No <br /> Are preservatives indicated? Yes, on sample containers ❑Yes,on COC ❑Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? N 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? E]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 Details <br /> Matrix-Wk- Container type #of containers received- <br /> Matrix <br /> eceivedMatrix Container type #of containers received <br /> Matrix Container type #of containers received <br /> Date and Time Sample Put into Temp Storage Date: Oglz_�((y Time: &721 <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) �On Both F-1Notindicated <br /> If Sample ID's are listed on both COC and containers,do they all match? Yes ❑No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) �-0n Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? MYes [-]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? ,pYes ❑No ❑NIA <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) P�tOn Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? VYes ❑No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 18 of 25 Page 8 of 8 <br />