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KIFF RECEIVER <br /> �e_ � <br /> Analvtical LLC SAMPLE RECEIPT CHECKLIST ( —In it <br /> SRG#: 9 Date: L t <br /> Project ID: <br /> Method of Receipt: Courier Over-the-counter Shipper <br /> COC Inspection <br /> Is COC present? Yes ❑No <br /> Custody seals on shipping container? 5Intact ❑Broken ❑Not present V�N/A <br /> Is COC Signed by Relinquisher? ZYes ❑No Dated? Yes ❑No <br /> Is sampler name legibly indicated on COC? Yes ❑No <br /> Is analysis or hold requested for all samples 9yes ❑No <br /> Is the turnaround time indicated on COC? zYes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? ❑Yes ❑No,Whiteout No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: ,L Z Yes �nitial___ <br /> s water 117i0 ❑ <br /> Temperature°C `i ` 3 Therm. ID# Date/Time N/A <br /> Are there custody seals on sample containers? intact ❑Broken Not present <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 ZN o <br /> Are any sample containers broken,lea ing or damaged? ❑YesNo <br /> Are preservatives indicated? Yes,on sample containers ❑Yes,on COC Not indicated ❑N/A <br /> Are preservatives correct for analyyye_s requested? Yes ❑No ❑N/A <br /> Are samples within holding time for analyses requested? Y <br /> Y <br /> Yes ❑No <br /> Are the correct sample containers used for the analyses requested? es ❑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? ❑Yes ]No <br /> Receipt Details <br /> Matrix Container type #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 Stora aDat : L t t 7l a Time: U7 <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? Yes _n No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? Wes NNo ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) K On Both []Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? ElYes ❑No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) f$J On Both [:]Not indicated <br /> If collection times are listed on both COC and containers,do they all match? KYes Li No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\sarnprec\Fortns\Swnple Receipt Checklist rev 051409.doc <br /> Page 9 of 9 <br />