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RECEIVER Analytical uc 0 SAMPLE RECEIPT CHECKLIST mina SRG#: 9 0 -_^5s Date: �! 2 y I/ �Z-- Project ID: Fo 'l EW L_i5sCo Fc i t—J T y Method of Receipt: Courier ver-the-counter Shipper COC Inspection Is COC present? Yes ❑No Custody seals on shipping container? ❑Intact ❑Broken ❑Not present At/A Is COC Signed by Relinquisher? Yes ❑No Dated? Yes ❑No / Is sampler name legibly indicated on OC? es ❑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? 4Yes ❑No,Whiteout ❑No,Cross-outs Sample Inspection Coolant Present: [ Yes ❑ (includes water Z 12l /3 3 Temperature°C 6- Therm.ID#� Initial L Date/Time !'Y ❑N/A Are there custody seals on sample containers? ❑Intact ❑Broken LgNot present Do containers match COC? ' es ❑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 ❑Yes,on COC [:]Not indicatedN/A Are preservatives correct for analyses requested? ❑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? Yes ❑No Does any sample contain product,have strong odor or are otherwise suI cted to be hot? ❑Yes NJ71 No Receipt Details l Matrix r�:7 Container type 02 [Qss#of containers received Itatrix Container type #of containers received Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Date: 02. 1 'L Time: d 3!9 uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) ZOn Both []Not indicated If Sample ID's are listed on both COC and containers,do they all match? [Z(Yes ❑No ❑N/A Is the Project ID indicated: ❑On COC ❑On sample container(s) Z On Both ❑Not indicated If project ID is listed on both COC and containers,do they all match? 0-Yes ❑No ❑NIA Are the sample collection dates indicated: ❑On COC ❑On sample container(s) .,nOn Both ❑Not indicated If collection dates are listed on both COC and containers,do they all match? Yes No E]N/A Are the sample collection times indicated: EJ On COC E]On sample containers) .2On Both ❑Not indicated If collection times are listed on both COC and containers,do they all match? PT^Yes ❑No ❑N/A COMMENTS: O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051499.doc Page 23 of 23