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• • • • • • • • • • • <br /> KIFFHAnalyticaluc SAMPLE RECEIPT CHECKLIST SRG#: <br /> Sample Recei t I Initials/Date: fel 1 Storage Time: A60D Sample Login Initials/Date: T�i a 1 Zo <br /> TAT: A Standard Rush Slit None Method of Receipt: Courier Over-the-counter Shipped <br /> Tem °C o2 N/A Therm ID (f 3 Time (60.5 Coolant resent ZYes No Water Temp Excursion <br /> For Shipments Only: Cooler Receipt Initials/Date rime: Custody Seals D NIA F1 Intact Broken <br /> Chain-of-Custody: Yes No Documented on COC Labels Discrepancies: <br /> Is COC resent? Sample ID X X <br /> Is COC signed by relinquisher? / Project ID X x <br /> Is COC dated by relin uisher? Sample Date x <br /> Is the sampler's name on the COC? Sample Time X <br /> Are there analyses or hold for all samples? Does COC match project history? N/A F Yes MNo <br /> Samples: N/A Yes No Comments: � } are r�JY°SeK7 j1 SrtN, C -v1 (WA -5-CfA <br /> Are sample custody seals intact? /fB 110#11 :414 <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 Cont 'ner Type #of Coritainers <br /> CS Required: <br /> Proceed With Analysis: ❑ YES ❑ NO IniUDate: <br /> CD <br /> N) Client Communication: <br /> Cn <br /> 0 <br /> LnN <br /> 0.Wo edlsampm FommstSampL Receipt Checklist rev 070113.doc <br />