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' RECEI <br /> KIFF Imtfals <br /> ' Analvtical LLC SAMPLE RECEIPT CHECKLIST <br /> SRG#: ( S6 Date: 401 <br /> Project ID: GT��q — r G0 <br /> 1 `7 <br /> ' Method of Receipt: Courier Over-the-counter Shipper <br /> COC Inspection 'Yes E]No <br /> Is COC present? ❑Intact El Broken [I Not present �Fl/A <br /> Custody seals on shipping container? <br /> Is COC Signed by Relinquisher? es ❑No Dated? XYes o <br /> No <br /> Is sampler name legibly indicated on OC? yes ❑No <br /> Yes <br /> analysis or hold requested for all samples Yes ❑No <br /> Is the turnaround time indicated on COC? []No,Whiteout []No,Crosscuts <br /> Is COC free of whiteout and uninitialed cross-outs? Yes <br /> Sample Inspection <br /> Coolant Present: �/ }Yes ❑No(includes water O N/A <br /> Temperature°C - "1 Therm.ID# �/L ' S Initial � ) IDceTime OO B �� 8 of present <br /> Are there custody seals on sample containers? ❑ No,Extra sam les resent <br /> ' Do containers match COC? -RYes ❑No ❑No,COC lists absent sample(s) ❑ P ( P <br /> Are there samples matrices oth r than soil,water,air or carbon? ❑Yes 4No <br /> Are any sample containers broken,leaking or damaged? ❑Yes <br /> es,on COC Not indicated ❑N/A <br /> Are preservatives indicated? ❑Yes,on sample containers ❑ ❑N/A <br /> ' Are preservatives correct for analyses requested? Yes No <br /> Are samples within holding time for analyses requested? Yes <br /> ❑No <br /> Are the correct sample containers used for the analyses requested? No <br /> Yes ❑❑No <br /> Is there sufficient sample to perform testing? es <br /> ' Does any sample contain product,have strong odor or are otherwise su petted to be hot? ❑YesNo <br /> Receiptwtails i Z <br /> Matrix /ems Container type VO #of containers received <br /> Matrix Container type #of containers received <br /> ' Matrix Container type #of containers rete v d <br /> Date and Time Sample Put into Temp Storage Date: O ( 13 O Time: <br /> ' uicklo On COC ❑On sample containers) �On Both ❑Not indicated <br /> Are the Sample ID's indicated: ❑ ❑ <br /> If Sample ID's are listed on both COC and containers,do they all match? Yes ❑No N/A <br /> On CO ❑On sample containers) �On Both Not indicated <br /> Is the Project ID indicated: ❑ ❑ <br /> If project ID is listed on both COC and containers,do they all match? Yes ❑No Bot N/p ❑Not indicated <br /> Are the sample collection dates indicated; ❑On COC ❑On sample containers) N/A <br /> If collection dates are listed on bot COC and containers,do ley all match? Yes ❑Nn Bot ❑Not indicated <br /> Are the sample collection times indicated: ❑On COC ❑On sample containers) ❑N/A <br /> If collection times are listed on bot COC and containers,do they all match? COYes No <br /> COMMENTS: <br /> 1 <br /> t <br /> ' O:WId edtsemprec\Foms'Saznple Receipt Checklist rev 051409.doe <br /> ' Page 12 of 12 <br />