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KI FF RECEIVER Analvtical i.l.c WW SAMP CEIPT CHECKLIST Initials SRG#: 3 71 Date: Project ID: (S I(.-f6sS T"2accL'!/17(r Method of Receipt: V5Courier ❑Over-the-counter ❑Shipper Shipping Only: ❑FedEx• ❑OnTrac" ❑Greyhound ❑Other *Service level if not Priority or Sunrise(M-F): COC Inspection Is COC present? Z Yes ❑No Custody seals on shipping container? Elintact [:]Broken ❑Not presen[,[5N/A Is COC Signed by Relinquisher? IXYes ❑No Dated? Z Yes ❑No Is sampler name legibly indicated on COC? ❑No Is analysis or hold requested for all samples? fes es E]No Is the turnaround time indicated on COC? es ❑No Is COC free of whiteout and uninitialed cross-outs? ❑Yes ❑No,WhiteouteNo,Cross-outs Sample Inspection Coolant Present: Yes ❑No(includes water) p�P�l 3 `�� Temperature°C 0 -`-I Therm.ID# S Initial 4 �' Date/Time ❑N/A Are there custody seals on sample containers? ❑Intact ❑Broken Not present Do containers match COC? ZYes ❑No ❑No,COC lists absent sample(s) EINo,Extra sample(s)present Are there samples matrices other than soil,water,air or carbon? E]Yes No Are any sample containers broken,leaking or damaged? ❑Yes TNO Are preservatives indicated? ❑Yes,on sample containers ZYes,on COC ❑Not indicated ❑N/A Are preservatives correct for analyses requested? 2ryes ❑No ❑N/A Are samples within holding time for analyses requested? VrYes ❑No Are the correct sample containers used for the analyses requested? Yes ❑No Is there sufficient sample to perform testing? Z Yes ❑No Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes /No Receipt De j xls p Matrix W� Container type V ol^, #of containers received I�' Matrix Container type #of containers received Matrix Container type # f containers received Date and Time Sample Put into Temp Storage Date: 0 f OPf 3 Time: l),off uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) On Both E]Not indicated If Sample ID's are listed on both COC and containers,do they all match? Wes nNo El N/A Is the Project ID indicated: g On COC ❑On sample container(s) ❑On Both ❑Not indicated If project ID is listed on both COC and containers,do they all match? ❑Yes ❑No KN/A Are the sample collection dates indicated: ❑On COC ❑On sample container(s) [ROn Both ❑Not indicated If collection dates are listed on both COC and containers,do they all match? EaYes ❑No ❑N/A Are the sample collection times indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated If collection times are listed on both COC and containers,do they all match? Yes ❑No ❑N/A COMMENTS: O:\old_ed\samprec\Fomts\Sample Receipt Checklist rev 072412.doc Page 12 of 12