Laserfiche WebLink
KIFFO RECEIVER <br /> Analytical LLC SAMPLE RECEIPT CHECKLIST Im ials <br /> SRG#: 774002, Date: X021.0 <br /> Project ID: <br /> Method of Receipt: Courier ver-the-counter Shipper <br /> COC Inspection <br /> Is COC present? [ 'Yes ❑No <br /> Custody seals on shipping container? ❑Intact ❑Broken ❑Not present �/A <br /> Is COC Signed by Relinquisher? []'fes ❑No Dated? �es ❑No <br /> Is sampler name legibly indicated on COC? ❑Yes E1190 <br /> Is analysis or hold requested for all samples P1es ❑No <br /> Is the turnaround time indicated on COC? L�-Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? 03fes ❑No,Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: es No(includes wate <br /> Temperature°C�_Therm.ID# 2 Initial_( Date/Time Ml214a 1 Q E]N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken E—Not present <br /> Do containers match COC? �es []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 0110 <br /> Are any sample containers broken, leaking or damaged? ❑Yes [7]No <br /> Are preservatives indicated? 2-1es,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? ETyes ❑No <br /> Are the correct sample containers used for the analyses requested? alll es ❑No <br /> Is there sufficient sample to perform testing? 21es ❑No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes <br /> Receipt Det i j 1 <br /> Matrix Container type ���i #of containers received <br /> Matrix Container type #of containers received <br /> Matrix Container type f containers received <br /> Date and Time Sample Put into Temp Storage Date: .. O Time: O <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) W10n Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers, do they all match? ❑Yes 2g No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) IQ On Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? U Yes ❑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? CgYes ❑No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) ,®An Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? 191 Yes ❑No ❑N/A <br /> COMMENTS: 532-5 HALF EFF u2ku c., n.Y lrc� <br /> Dv ec,A� a� Glee�k I�bel v�L�cc� <br /> L i0 C'S 5725 HAU_ FFE nA_6-5 ORO-2—ID 1139 <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 9 of 10 Page 8 of 8 <br />