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KIFF RECEIVER <br /> Aryalvtical LLC SA?WE RECEIPT CHECKLIST / Initials <br /> SRG#: 75795 Date: 1 <br /> Project 1D: 13 6' Aj 0 :9 0 <br /> Method of Receipt: El Courier ver-the-counter Shipper <br /> COC Inspection <br /> Is COC present? Yes ❑No <br /> Custody seals on shipping container? ❑Intact ❑Broken ❑Not presentAN/A <br /> Is COC Signed by Relinquisher? Yes ❑No Dated? Yes ❑No <br /> Is sampler name legibly indicated on OC? Yes ❑No <br /> Is analysis or hold requested for all samples Yes ❑No <br /> Is the turnaround time indicated on COC? Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? Yes ❑No, Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: Yes tL;X No(includes water) <br /> Temperature°C Therm. ID#� Initialer Date/Time 2-16 1 O/I � ❑N/A <br /> Are there custody seals on sample containers? 2 ❑Intact ❑Broken Not present <br /> Do containers match COC? Yes ❑No ❑No,COC lists absent sample(s) ❑No, Extra sample(s)present <br /> Are there samples matrices oth r than soil,water,air or carbon? ❑Yes No <br /> Are any sample containers broken, leaking or damaged? ❑Yes No <br /> Are preservatives indicated? ❑Yes, on sample containers Yes,on COC Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? Ja Yes ❑No ❑N/A <br /> Are samples within holding time for analyses requested? Yes ❑No <br /> Are the correct sample containers used for the analyses requested? Yes ❑No <br /> Is there sufficient sample to perform testing? Yes ❑No <br /> Does any sample contain product,have strong odor or are otherwise s pected to be hot? ❑Yes �Vo <br /> Receipt Details //!— <br /> Receix� Container type #of containers received <br /> Matrix Container type #of containers received_ <br /> Matrix Container type of containers receive <br /> Date and Time Sample Put into Temp Storage Date: 2 Time: <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) ,NODn Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers, do they all match? es ❑No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If project ID is listed on both COC and containers, do they all match? Yes ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) ,®On Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? 2)Yes ❑No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) ,�On Both ❑Not indicated <br /> If collection times are listed on both COC and containers, do they all match? FgpYes ❑No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 8 of 8 <br />