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RecraveR KIFFO Analvtical tt.c SAMPLE RECEIPT CHECKLIST - SRG#: 5 Dilate: Project ID: Method of Receipt: Courier Over-theounter El ShiMer COC Inspati n Is COC present? Yes []No Custody seals on shipping container? Intact ❑Broken E)Not present1VlA Is COC Signed by Relinquisher? IRYes [:3 No Dated? 41 Yes [:]No Is sampler name legibly indicated on C7 91 Yes ❑No Is analysis or hold requested for all samples Yes ❑No Is the tumaround time indicated on COC? MY@s []No Is COC&ce of whiteout and uninitialed cross-outs? Yes ❑No,Whiteout ❑No,Cross-outs Sample Inspection Temperaturen � Yes C]No(includes water) Ol o3oq /rz ( ❑N/A j r �' o C erm.ID# TO - — initial L �terrime ` Are there custody seals on sample containers? 0 Intact ❑Broken ONot present Do containers match COC? A Yes ❑No ❑No,COC lists absel t sample(s) [:]No,Extra sample(s)present i Are there samples matrices other than soil,water,air or carbon? IYes Callo Are any sample containers broken,leaking or datnaged? ❑Yes MNo Are preservatives indicated? ( Yes,on sample containers ❑I Yes,on COC Not indicated ❑NIA Are preservatives correct for analys¢s _requested? Yes []No ❑NIA 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 suspected to be hot? ❑Yes [ Na Receipt i Matrix W A► Container type_V 4.�}_ !€of coma ers received Matrix Container type #of containers received Matrix Container type #of conta ers received Date and Time Sample Put into Temp Storage Date: 4 Time: 3 0 { uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) ,®On Both ❑Not indicated If Sample ID's are listed on both COC and containers,do they all match?II -QYes []No ❑N!A Is the Project name indicated: On COC �pn sample container(s) ❑Not indicated If project name is listed on both COC and c tainers,do they all match? KYes ❑No ❑NIA ! Are the sample collection dates indicated: On COC nOn sample container(s) E]Not indicated If collection dates are listed on both COC mid do the all math? ZJYes C)No ❑N/A Are the sample collection times indicated: P On COC On sample container(s) ❑Not indicated If collection times are listed on both COC and containers,do ey all match? Yes ❑No _]N/A f,s ons F - COMMENTS: `12 5 o a G _ — �-_7y�_ 03 9, 1309 i SR CHECKLIST UV 05-1 4.09.?C*P 032609 I