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Kl FF RECEIVER <br /> Analytical LLC SAMPLE RECEIPT CHECKLIST ,Initials <br /> SRG#: 9( Date: O �� <br /> Project ID: ?c,,C�C{� <br /> Method of Receipt: Courier er-the-counter ❑Shipper <br /> COC Inspection <br /> Is COC present? 2-Yes ❑No <br /> Custody seals on shipping container? ❑Intact ❑Broken ❑Not present $DeN/A <br /> Is COC Signed by Relinquisher? VYes ❑No Dated? ®'Yes ❑No <br /> Is sampler name legibly indicated on COC? ' Yes ❑No <br /> Is analysis or hold requested for all samples Yes ❑No <br /> Is the turnaround time indicated on COC? D4 Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? Yes [—]No,Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: `YesNo(includes wat _ <br /> Temperature°C a. 5 Therm.ID# r Initial Date/Time ! f* E]N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken [!*Not present <br /> Do containers match COC? rKYes ❑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 E;�No <br /> Are any sample containers broken,leaking or damaged? ❑Yes No <br /> Are preservatives indicated? Xyes,on sample containers ❑Yes,on COC LJ Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? Ryes ❑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? 9Yes ❑No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes J No <br /> Receipt Details ' <br /> Matrix LJ/1- Container type ld�( W #of containers received �— <br /> Matrix Container type I c r,.� #of containers received 3 <br /> Matrix_ Container type Tt_gk..r #of containers received <br /> Date and Time Sample Put into Temp Storage Date: J Time: i;)LS 3 <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) �W)n Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? OYes ❑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? ❑Yes ❑No �N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) ,.FFOn Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? �9 Yes ❑No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If collection times are listed on both COC and containers, doh theyallmatch? Yes ❑No �7 ❑N/A <br /> COMMENTS: OU 6 t S l '" 07 — `w t/�— D�) 1 " 2 / <br /> Wold_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 30 of 30 <br />