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KI FF 0 RECEIVER <br /> Analvtical uc SAMPLE RE EIPT CHECKLIST ht'`MRIs <br /> SRG#: 715 � Date: 0113 110 <br /> Project ID: SGj 1,C{ LQ e — 1/l CO 1!!� <br /> Method of Receipt: Courier D Over-the-counter Shipper <br /> COC Inspection ,���,,,�,""" <br /> E] E]' Is COC present? Yes ElNo <br /> Custody seals on shipping container? (les <br /> tact Broken Not present fCYN/A <br /> Is COC Signed by Relinquisher? �J es ❑No Dated? es E]No J <br /> Is sampler name legibly indicated on OC? es o <br /> Is analysis or hold requested for all samples es o <br /> Is the turnaround time indicated on COC? es E)No <br /> Is COC free of whiteout and uninitialed cross-outs? ❑No,Whiteout []No,Cross-outs <br /> ' Sample Inspection <br /> Coolant Present: �J }Yes No includes water �j I I / <br /> Temperature°C 2' I Therm.ID# �f2—� Initial l�J !� Date/Time I 3 J D/I l7 l 9 ❑N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken of present <br /> Do containers match COC? IzYes []No ❑No,COC lists absent sample(s) No,Extra sample(s)present <br /> Are there samples matrices othef than soil,water,air or carbon? E]Yes No <br /> Are any sample containers broken, leaking or damaged? El Yes o <br /> Are preservatives indicated? E)Yes,on sample containers Yes,on COC of indicated ❑N/A <br /> Are preservatives correct for analyses requested? es ❑No ❑N/A <br /> Are samples within holding time for analyses requested? 1pected <br /> es L]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 su to be hot? ❑Yes >ZNo <br /> Receipt Details 'I <br /> Matrix Container type V O /'�'F #of containers received `T <br /> ' Matrix Container type #of containers received <br /> Matrix Container type l 3#;f containers rec@iv d <br /> Date and Time Sample Put into Temp O I Storage Date: 0 Time: <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) On Both F1 Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? Wes No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) �Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? 1®Yes U No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) 4jt�Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? kEYes LJ No ❑N/A <br /> ' Are the sample collection times indicated: ❑On COC ❑On sample containerSs) n Both El Not indicated <br /> If collection times are listed on both COC and containers,do they all match? [ees LNo ❑N/A <br /> COMMENTS: <br /> r <br /> O:old_ed\s=prec\FomslS=ple Receipt Checklist rev 051409.dm <br /> Page 32 of 32 <br />