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Kl FF RECEIVER <br /> Analvtical LLC SAMPLE RE PT CHECKLIST Initials <br /> SRG#: `7 3(� 2— Date: 0 707 1 <br /> Project ID: es — f` -1 to 0 n <br /> Method of Receipt: Courier Over-the-counter Whipper <br /> COC Inspection <br /> Is COC present? es ❑No <br /> Custody seals on shipping container? ntact ❑Broken ❑Not present ❑N/A <br /> Is COC Signed by Relinquisher? Oyes ❑No Dated? es ❑No <br /> Is sampler name legibly indicated on COC? Yes o <br /> Is analysis or hold requested for all samples [ Yes No <br /> Is the turnaround time indicated on COC? 5Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? Wes ❑No, Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: � WYes No includes water l <br /> Temperature°C � Therm. ID# �-5 Initial Date/Time 07O7i 0/ 1'7 <br /> 1 ❑N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken Wot present <br /> Do containers match COC? �OI'es ❑No ❑No,COC lists absent sample(s) Q No,Extra sample(s)present <br /> Are there samples matrices other than soil,water,air or carbon? ❑Yes ETNo <br /> Are any sample containers broken,leaking or damaged? ❑Yes XpNo <br /> Are preservatives indicated? es,on sample containers ❑Yes,on COC ❑Not indicated ❑N/A <br /> Are preservatives correct for analys s requested? Yes ❑No ❑N/A <br /> Are samples within holding time for analyses requested? M 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 sus ected to be hot? ❑Yes 2JNo <br /> Receipt Details l <br /> Matrix✓& Container type `/p #of containers received ! I <br /> Matrix Container type #of containers received <br /> Matrix Container type #of containers rece ved <br /> Date and Time Sample Put into Temp Storage Date: 0 707 10 Time: 730 <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) Q0n Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? ZYes [:]No ❑N/A <br /> Is the Project ID indicated: E]On COC ❑On sample container(s) LgOn Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? .0 Yes ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample contain r(s) RTOn Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? Yes No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? Oyes No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 11 of 13 pagVM/1Zp10 <br />