Laserfiche WebLink
FF RECEIVER <br /> 1<1 <br /> Analvtical 1_Lc SAMPLE CEIPT CHECKLIST Initials <br /> SRG#: �7 �Z Date: 0 7'-J- 1 <br /> Project ID: <br /> Method of Receipt: Courier ver-the-counter 0 Shipper <br /> COC Inspection <br /> Is COC present? [Ayes ❑No <br /> Custody seals on shipping container? ❑Intact ❑Broken ❑Not present�V/A <br /> Is COC Signed by Relinquisher? es ❑No Dated? OYes [:]No <br /> Is sampler name legibly indicated on OC? Yes f�pNo <br /> Is analysis or hold requested for all samples OYes ❑No <br /> Is the turnaround time indicated on COC? Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? Yes ❑No, Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: t Yes F1 No <br /> (includes water) <br /> Temperature°C "1 '7 Therm. ID# -_7r-:: ' 'Z Initia� Date/Time O 7 0 ❑N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken of present <br /> Do containers match COC? Yes EJ No E]No, COC lists absent sample(s) [J No,Extra sample(s)present <br /> Are there samples matrices other 1,an soil, water,air or carbon? ❑Yes No <br /> Are any sample containers broken,leaking or damaged? ❑Yes 0 <br /> Are preservatives indicated? ❑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? I Yes ❑No <br /> Does any sample contain product, have strong odor or are otherwise suspected to be hot? ❑Yes )&�VNo <br /> Receipt Details <br /> Matrix_VVIO� Container type V0 #of containers received I I <br /> Matrix Container type #of containers received <br /> Matrix Container type #of containers received <br /> Date and Time Sample Put into Temp Storage Date: 0-70 I '0 Time: <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample contain r(s) On Both ❑Not indicated <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: E]On COC E]On sample conta r(s) On Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? Yes ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On samp a container(s) On Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? es E]No E]N/A <br /> Are the sample collection times indicated: E]On COC E]On sample conta er(s) $0 On Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? q_/1 Yes ❑No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 11 of 12 pagV"/1Zp10 <br />