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KIFF0 RECEIVER Analytical I.>.c SAMPLE RECEIPT CHECKLIST Ts trtitials SRG#: �g3p Date: Project ID: IAA6V_ v&A S`.lvl 4S2_ — Method of Receipt: Courier Over-the-counter Shipper COC Inspection Is COC present? ®Yes ❑No Custody seals on shipping container? Intact ❑Broken ❑Not present AN/A Is COC Signed by Relinquisher? �Z Yes ❑No Dated? iYes ❑No Is sampler name legibly indicated on COC? W Yes ❑No Is analysis or hold requested for all samples ®Yes ❑No Is the turnaround time indicated on COC? ®Yes ❑No Is COC free of whiteout and uninitialed cross-outs? (K Yes ❑No,Whiteout ❑No,Cross-outs Sample Inspection Coolant Present: ( Yes ❑No(includes water) Temperature°C 0,(0 Therm.ID# T-2-Z Initial _7�!r6 Date/Time �I� 1 S� ❑N/A Are there custody seals on sample containers? ❑Intact ❑Broken Not present Do containers match COC? MYes ❑No ❑No,COC lists absent sample(s) ❑No,Extra sample(s)present Are there samples matrices other than soil,water,air or carbon? ❑Yes ®No Are any sample containers broken, leaking or damaged? ❑Yes No Are preservatives indicated? [J Yes,on sample containers ❑Yes,on COC [:]Not indicated X N/A Are preservatives correct for analyses requested? C]Yes [:]No N/A Are samples within holding time for analyses requested? ®Yes ❑No Are the correct sample containers used for the analyses requested? Yes ❑No Is there sufficient sample to perform testing? r9Yes ❑No Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes No Receipt Details 3 Matrix__ Container type _5102A^#_ #of containers received Matrix Container type #of containers received Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Dake: 1 WZ0 Time: 1�D uicklo Are the Sample ID's indicated: ❑On COC ❑On sample containers) On Both ❑Not indicated If Sample ID's are listed on both COC and containers,do they all match? eyes nNo ❑N/A Is the Project ID indicated: [:]On COC ❑On sample container(s) n Both [JNot indicated If project ID is listed on both COC and containers,do they all match? Yes ]No ❑N/A Are the sample collection dates indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated If collection dates are listed on both COC and containers,do they all match? cB Yes LJ 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? �-Xes �No ❑N/A COMMENTS: 0:\old_ed\samprec\Forrns\Sample Receipt Checklist rev 051409.doc Page 10 of 10