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J 1 KIFF � `"'� RECEIVER rt16 Analytical LLC SAMPLE RECEIPT CHECKLIST Initials SRG#: 3 Date: Project ID: _m f9 <✓In Method of Receipt: Courier IR Over-the-counter Shipper COC Inspection Is COC present? ZYes ❑No Custody seals on shipping container? ❑Intact ❑Broken ❑Not present,&N/A Is COC Signed by Relinquisher? E,Yes ❑No Dated? 5fl Yes ❑No Is sampler name legibly indicated on COC? M Yes ❑No Is analysis or hold requested for all samples Yes ❑No Is the turnaround time indicated on COC? N Yes ❑No Is COC free of whiteout and uninitiated cross-outs? 2gYes [:]No, Whiteout ❑No,Cross-outs Sample Inspection Coolant Present: NYes ❑Nocludes water Temperature°C .3,G Therm. ID# �inInitial = Date/Time 1 12c)q ❑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) ❑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? ❑Yes,on sample containers EJYes,on COC ❑Not indicated N NIA Are preservatives correct for analyses requested? ❑Yes ❑No ®N/A Are samples within holding time for analyses requested? [K Yes ❑No Are the correct sample containers used for the analyses requested? ®Yes ❑No Is there sufficient sample to perform testing? RYes ❑No Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes 7LNo Receipt Details 8 Matrix Container types teV-1— #of containers received o Matrix Container type #of containers received Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Date: I L I Z d 6 Time:- 16 uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) 25-On Both ❑Not indicated If Sample ID's are Iisted on both COC and containers,do they all match? XYes ❑No ❑N/A Is the Project ID indicated: ❑On COC ❑On sample container(s) A$On Both ❑Not 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? W Yes �No ❑N/A Are the sample collection times indicated: ❑On COC ❑On sample container(s) 40n Both ❑Not indicated If collection times are listed on both COC and containers,do they all match? ®-Yes ❑No ❑N/A COMMENTS: 0Aold_ed\samprec\Forms\.Samp1c Receipt Checklist rev 051409.doc Page 8 of 8