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KIFF RECEIVER <br /> P44- <br /> Analytical LLC SAMPLE ]RECEIPT CHECKLIST Initials <br /> SRG#: Date: 072,41-o <br /> Project ID: <br /> Method of Recei t: rier Over-the-counter Shipper <br /> COC Inspection <br /> Is COC present? e No <br /> Custody seals on shipping container? act E]Broken E]Not present ❑N/A <br /> Is COC Signed by Relinquisher? [?'Yes ❑No Dated? 21es ❑No <br /> Is sampler name legibly indicated on COC? ❑Yes e?No <br /> Is analysis or hold requested for all samples L "des ❑No <br /> Is the turnaround time indicated on COC? ,[i]'fes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? �1 es ❑No, Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: Eves ❑No includes wat ) <br /> Temperature°C 3 .'2_ Therm. ID# j Initial Date/Time07L11��❑N/A <br /> Are there custody seals on sample containers. ❑Intact ❑Broken E Rot present <br /> Do containers match COC? ❑Yes 2 Io <o,COC lists absent sample(s) ❑No,Extra sample(s)present <br /> Are there samples matrices other than soil,water, air or carbon? ❑Yes <br /> Are any sample containers broken, leaking or damaged? E]Yes P10 <br /> Are preservatives indicated? 21es,on sample containers ❑Yes,on COC ❑Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? „B'Yes ❑No ❑N/A <br /> Are samples within holding time for analyses requested? �es F]No <br /> Are the correct sample containers used for the analyses requested? ,eles ❑No <br /> Is there sufficient sample to perform testing? ffKes ❑No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes 0<0 <br /> Receipt Det 'ls <br /> Matrix Container type #of containers received <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 72,/10 Time: lam_ <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? fKYes No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) 5dOnBoth ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? 0Yes 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? YesfNo <br /> o E]N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample contatner(s) n Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? E]Yes ❑N/A <br /> COMMENTS: OX 0,4 CdC <br /> �} Q /Z:. f ao,.O GOC <br /> A&I / i4AW &W410 <br /> O:\old_ed\samprecTorms\Sample Receipt Checklist rev 051409.doc <br /> Page 10 of 11 p99d:PVU10 <br />