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• • • • • • • • • • • <br /> KIFFOAnalwicaluc SAMPLE RECEIPT CHECKLIST f-fSI <br /> Sam le Recei t Initiais/Date: ` lto�- 13 Stora a Time: 400D IsampleLogin Initials/Date: T3-B (IUCD f 3 <br /> TAT: Standard Rush Split None/ Method of Receipt: Courier Over-the-counter ED Shi ed <br /> Tem °C 'tlEN/A Therm ID I -I Time j Coolant present ZI Yes F1 No F1 Water Temp Excursion <br /> For Shipments Only: Cooler Receipt Initials/Date/rime: Custod Seals El N/A Intact Broken <br /> Chain-of-Custody: Yes No Documented on COC Labels Discrepancies: <br /> Is COC resent? Sample ID <br /> Is COC signed by relin uisher? Project ID x <br /> Is COC dated by relin uisher? Sample Date <br /> Is the sampler's name on the COC? / Sam le Time �X_ <br /> Are there analyses or hold for all samples? Does COC match project history? I N/A E Yes FNo <br /> Samples: NIA Yes No Comments: -11�0- skha es 4;r SGL,,,a -0z -o Y a n d -06 <br /> Are sample custody seals intact? Cfc"'w4 C4hc%e-S . 7z- is 1(0(01 i zoab <br /> Are sample containers intact? ?� <br /> Is preservation documented? <br /> In-house Analysis: NIA 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 /> 0/ <br /> 09 CS Required: <br /> CD Proceed With Analysis: ❑ YES ❑ NO Init/Date: <br /> N Client Communication: <br /> 0 <br /> M <br /> w <br /> N <br /> olofd edl5amp %Fo Svsample Receipt Checklist rev 070773.doc <br />