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GFF O / <br /> na►vdcaluc SAMPLE RECEIPT CHECKLIST SRG#: <br /> Sample Receipt I Initials/Date: ( ( Stora a Time: kD'2�J I Sample Login Initials/Date: d Cl 2-(o l <br /> TAT: Standard Rush S lit None Method of Receipt: Courier Z Over-the-counter Shipped <br /> "emp °C �j�. NIA I Therm ID 3 Time 1&17 Coolant present OYes No Water Temp Excursion <br /> For Shipments Only: Cooler Receipt Initials/Date/Time: TC—Ustody Seals N/A Lj Intact Broken <br /> '.hain-of-Custody: Yes No Documented on COC Labels Discrepancies: <br /> s COC resent? Sample ID ,/ <br /> s COC signed by relin uisher? Project ID / <br /> V— <br /> s COC dated by relin uisher? Sample Date <br /> s the sampler's name on the COC? Sample Time <br /> kre there analyses or hold for all samples? Does COC match project histo ? N/A WL3 No <br /> Sam les: N/A Yes No Comments: <br /> Ve sample custody seals intact? <br /> Ore 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 /> CS Required: <br /> Q Proceed With Analysis: ,YES ❑ NO Init/Date:�Q12?1?j <br /> o Client Communication: <br /> TG-Y og27 i3 <br />