Laserfiche WebLink
KI FFMW REC J-6a <br /> Analvdcal ILC SAMPLECEIPT CHECKLIST <br /> Initials <br /> SRG#: C1Date: <br /> Project ID: �� L e2 — L i,Ccs n� <br /> ' Method of Receipt: ourier Over-the-counter 7 Shipper <br /> COC Inspection <br /> ' Is COC present? Ryes ❑No <br /> Custody seals on shipping container? U Intact ❑Broken ❑Not present [&NIA <br /> Is COC Signed by Relinquisher? ®Yes ❑No Dated? ®Yes ❑No <br /> Is sampler name legibly indicated on COC? Dyes gNo <br /> ' Is analysis or hold requested for all samples JZYes El No <br /> Is the turnaround time indicated on COC? Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? RYes ❑No,Whiteout ❑No,Cross-outs <br /> ' Sample Inspection <br /> Coolant Present: oQYes ❑No(includes water) <br /> Temperature°C -L `i Therm.ID# W=- S Initial D& Date/Time e 7 Z`1*�j//9 S ❑N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken E)Not present <br /> Do containers match COC? 4Yes ❑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 ZNo <br /> Are any sample containers broken, leaking or damaged? ❑Yes o <br /> Are preservatives indicated? 0Yes,on sample containers Yes,on COC Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? Yes El El 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 E]No <br /> Is there sufficient sample to perform testing? Yes ❑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 VOA #of containers received 5 D <br /> ' Matrix Container'" #of containers received <br /> Matrix Container type #of containers received <br /> Date and Time Sample Put into Temp Storage Date: g� Time: 200 0 <br /> ' uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample contain (s) n Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? Mes ]]No ❑N/A <br /> ' Is the Project ID indicated: ❑On COC ❑On sample containers) n Both Not indicated <br /> If project ID is listed on both COC and containers,do they all match? yes [No E]❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On saihple container(s) ;3bn Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? Ofes [LNo ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) n Both ❑Not indicated <br /> ' if collection times are listed on both COC and containers,do they all match? f'Yes El No ElN/A <br /> COMMENTS: —10 hA5 A f I M( 0/- ` -` 1 <br /> 10 Or) 1 ke— Vo/Is L-)72 07ZSoq-075 Z <br /> ' O:Wd_edlsamprec\Forms\Sample Receipt Checklist rev 051409.doc <br />