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1<1FF0 RECEIVER Analvtical cr_C SAMPLE RECEIPT CHECKLIST In�s- SRG#: `7S Z2 Date: I��q I Project ID: If Q / ',Q .-J-0J( 1 0 Gl r)d :J9Y'� �, j Z v-04+ Method of Receipt: ourier Over-the-counter Shipper COC Inspection Is COC present? Yes ❑No Custody seals on shipping container? Intact ❑Broken ❑Not present'93�/A Is COC Signed by Relinquisher? OYes ❑No Dated? es EJNo Is sampler name legibly indicated on COC? Yes F]No Is analysis or hold requested for all samples Yes E]No Is the turnaround time indicated on COC? Yes E]No Is COC free of whiteout and uninitialed cross-outs? E]Yes F-1 No, Whiteout �lo,Cross-outs Sample Inspection Coolant Present: W Yes E]No(includes water) 1 / Temperature°C 0"� Therm. ID#Ml InitiaDate/Time I 'l7)�'1 O 17 SCS ❑N/A Are there custody seals on sampl containers? ❑Intact E]Broken Not present Do containers match COC? Yes E]No ❑No, COC lists absent sample(s) E]No,Extra sample(s)present Are there samples matrices oth r than soil, water,air or carbon? E]Yes No 9 Are any sample containers broken, leaking or damaged? E]Yes No Are preservatives indicated? ❑Yes,on sample containers Yes,on COC PNot indicated ❑N/A Are preservatives correct for analyses requested? Yes ❑No ❑N/A Are samples within holding time for analyses requested? es ❑No Are the correct sample containers used for the analyses requested? Yes ❑No Is there sufficient sample to perform testing? Yes ❑No Does any sample contain product,have strong odor or are otherwise su ected to be hot? ❑Yes �Io Receipt Details // Matrix /fir- Container type �{^��e� #of containers received Matrix 4Z Container type #of containers received Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Date: 1 Q 1 a Time: I $ 17 uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) dS�On Both ❑Not indicated If Sample ID's are listed on both COC and containers,do they all match? Gs�Yes ❑No ❑N/A Is the Project ID indicated: ❑On COC ❑On sample container(s) Gpg:On Both ❑Not indicated If project ID is listed on both COC and containers,do they all match? dices ❑No ❑N/A Are the sample collection dates indicated: ❑On COC ❑On sample container(s) n Both ❑Not indicated If collection dates are listed on both COC and containers,do they all match? e�'es ❑No ❑N/A Are the sample collection times indicated: ❑On COC ❑On sample containe (s) i n Both E]Not indicated If collection times are listed on both COC and containers,do they all match? 'es ❑No ❑N/A COMMENTS: O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc Page 139 of 139