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(IFF 0 / <br /> nalvticalu.c SAMPLE RECEIPT CHECKLIST SRG#: <br /> Sample Receipt I Initials/Date: 0t7-(�Ostorage Time: 1O2�'J I Sample Login Initials/Date: d Cl 2-(o l <br /> TAT: Standard Rush split None Method of Receipt: Courier Over-the-counter Shipped <br /> "em °C �j�- N/A I Therm ID 3 Time 7 Coolant resent Yes No Water Tem Excursion <br /> For Shipments Only: Cooler Receipt Initials/Date/Time: Custody Seals ❑ N/A ❑ Intact Broken <br /> chain-of-Custody: Yes No Documented on COC Labels Discrepancies: <br /> s COC resent? Sample ID ............ <br /> y'' <br /> s COC signed by relin uisher? Project ID / <br /> s COC dated by relin uisher? Sample Date <br /> s the sampler's name on the COC? Sample Time of <br /> Nre there analyses or hold for all samples? Does COC match project history? 2fNIA w3 No <br /> Samples: NIA Yes No Comments: <br /> Are sample custody seals intact? <br /> Are sample containers intact? <br /> Is preservation documented? <br /> In-house Analysis, N/A Yes No <br /> Are preservatives acceptable? <br /> Are samples within holding time? <br /> Are sample container types correct? <br /> Is there adequate sample volume? <br /> Receipt Details: <br /> Matrix Container Type # of Containers <br /> � c�J <br /> CS Required: <br /> Q Proceed With Analysis: ,YES [:] NO Init/Date:U Q, 2-713 <br /> o Client Communication: <br /> TG-Y og27i3 <br />