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• • • A • • • • • • • <br /> iKIFFH <br /> Analytical uc SAMPLE RECEIPT CHECKLIST ISRG#: 2L25 <br /> Sample Receipt 1 Initials/Date: toIii 3 Storage Time: 73357 1 Sample Login Initials/Date: tNO6 1p 3 <br /> TAT: Vj Standard Rush Split None Method of Receipt: 0 Courier Over-the-counter El Shipped <br /> Tem °C �• N/A I Therm ID t%%� Coolant present 71 Yes No F1 Water Temp Excursion <br /> For Shipments Only- Cooler Receipt Initials/Date/Time: Custod Seals N/A Intact Broken <br /> Chain-of-Custody: Y04 No Documented on COC Labels Discre ncies: <br /> Is COC resent? Sample ID c o <br /> Is COC signed by relin uisher? Project ID <br /> Is COC dated by relin uisher? Sample Date <br /> Is the sampler's name on the COC? 1 Sample Time 4— 'K <br /> Are there analyses or hold for all samples? Does COC match project history? M N/A Yes nNo <br /> Samples: NIA YesjNo <br /> Comments: -Ir7 a. t2fa� a-A- <br /> Are sample custodyseals intact? �1 �� e r <br /> Are sample containers intact? -0"1 1�4�— ©k'l5w� <br /> Is reservation documented? ruler= l <br /> In-house Analysis: NIA Yes <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 /> �e.Gvtr o'L'O <br /> 0 <br /> CS Re uired: <br /> m Proceed With Analysis: ❑ YES ❑ NO Init/Date: <br /> P. Client Communication: <br /> 4 <br /> o_ <br /> A <br /> V <br /> 0 W1d edlsamPw1Fomts0amp1e Receipt checklist rev o7o, 3.doc <br />