Laserfiche WebLink
KIFF <br /> RECEIVER <br /> 01yZ5 <br /> Analvtical LLC SAMPLE RECEIPT CHECKLIST Initials <br /> SRG#: _ '7_5q:5 <br /> A7_ q 5 7- Date: &10 S-// <br /> Project ID: NO-54/e—k/ PQ" <br /> Method of Receipt: ❑Courier El Over-the-counter Shipper <br /> COC Inspection <br /> Is COC present? R Yes ❑No <br /> Custody seals on shipping container? ®Intact ❑Broken ❑Not present ❑N/A !I <br /> Is COC Signed by Relinquisher? Q7C Yes ❑No Dated? M Yes ❑No <br /> Is sampler name legibly indicated on COC? ❑Yes No <br /> Is analysis or hold requested for all samples ]Yes nNo <br /> Is the turnaround time indicated on COC? Q Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? ®Yes ❑No,Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: 53Yes ❑No(includes water) <br /> Temperature°C S"Z Therm. ID# Tg-5- Initial j I& Date/Time a/Qs/l l 6 Z - ❑N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Br cen g Not present i <br /> Do containers match COC? Z]Yes ❑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 X]No <br /> Are any sample containers broken,leaking or damaged? ❑Yes ®No <br /> Are preservatives indicated? 9'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? Yes ❑No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes RNo <br /> Receipt Det ils <br /> Matrix .1 Container type VOA #of containers received 5_0 <br /> Matrix Container type #of containers received <br /> Matrix Container type #of containers received <br /> Date and Time Sample Put into Temp Storage Date:C IC61( Time: <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) f�fOn Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? Yes ❑No E]N/A <br /> Is the Project ID indicated: EJ On COC E]On sample container(s) On Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? <2 Ces ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) CR On Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? tQ s ❑No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s)e�WOn Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? ic*es ❑No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 25 of 25 <br /> Page 54 of 60 01/12/2011 <br />