Laserfiche WebLink
KIFFO RECEIVER <br /> Analvtical LLC SAMPLE RECEIPT CHECKLIST Initials <br /> SRG#: Date: ovf to <br /> Project ID: <br /> Method of Receipt: Courier O'6ver-the-counter Shipper <br /> COC Inspection <br /> Is COC present? Qhs ❑No <br /> Custody seals on shipping container?�-,� El intact ❑Broken ❑Not present 2-<AL2 <br /> Is COC Signed by Relinquisher? r es ❑No Dated? Q es ❑No <br /> Is sampler name legibly indicated on COC? ❑Yes E�o <br /> Is analysis or hold requested for all samples 2'1 es ❑No <br /> Is the turnaround time indicated on COC? 2"�;s ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? Yes ❑No, Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: P11yes No(includes water G <br /> Temperature°C Therm. ID# /? Initial Date/Time 09)91(10 N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken of present <br /> Do containers match COC? E?les ❑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 [;?<9Are any sample containers broken, leakier 9 <br /> or damaged? ❑Yes leo <br /> Are preservatives indicated? Elles,on sample containers ❑Yes,on COC ❑Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? [, -Tes ❑No ❑N/A <br /> Are samples within holding time for analyses requested? Owes ❑No <br /> Are the correct sample containers used for the analyses requested? � E]No <br /> Is there sufficient sample to perform testing? 'es ❑No � <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? E]Yes ?oo <br /> Receipta t i s i^- <br /> M10Container type &*OL-' #of containers received O <br /> Matrix Container type #of containers received <br /> Matrix Container type #of containers received <br /> Date and Time Sample Put into Temp Storage Date: Time: <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) eOn Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? 21?es ❑No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) t?On Both ❑Not indicated <br /> If project ID is listed on both COC and containers, do they all match? [TYes ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample containe s) 210n Both E]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) ffOn Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? F1 Yes ❑No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 9 of 10 Page 8 of 8 <br />