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KI FF O <br /> Analvtical[.cc SAMPLE RECEIPT CHECKLIST ISRG#: <br /> Sample Receipt I Initials/Date: u'l$ O 4i(il4 Stora a Time: ' ,5 I'�5Sam le Login Initials/Date: 1 v` O 416 l y <br /> TAT: ❑ Standard ❑ Rush 0 Split ❑ None Method of Receipt: ❑ Courier K Over-the-counter ❑ Shipped <br /> Tem °C 1 5, N/A I Therm ID:tit- Time Coolant present 2 Yes No Water Temp Excursion <br /> For Shi ments Only: Cooler Receipt Initials/Date/Time: Custody Seals N/A 0 Intact Broken <br /> Chain-of-Custody: Yes No Documented on COC Labels Discrepancies: <br /> Is COC resent? Sample ID <br /> Is COC signed by relin uisher? Project ID <br /> Is COC dated by relin uisher? Sample Date <br /> Is the sampler's name on the COC? X Sample Time <br /> Are there analyses or hold for all samples? Does COC match project history? N/A XYes ` No <br /> Samples: N/A Yes No Comments: g„ibS , S awc�� c l b�iv Vd4s�. �J15 C► �61 <br /> Are sample custody seals intact? Rd <br /> Are sample containers intact? <br /> Is preservation documented? <br /> In-house Analysis: N/A Yes No <br /> Are preservatives acceptable? <br /> Are samples within holding time? <br /> Are sample container types correct? x <br /> Is there adequate sample volume? <br /> Receipt Details: <br /> Matrix Container Type # of Containers <br /> r WA 6A 0- r?► <br /> v0a q q CS Required: <br /> +-,) /��,►„yy� Proceed With Analysis: ❑ YES ❑ NO Init/Date: <br /> Client Communication: <br /> 01old edlsampredFormslsample Receipt Checklist rev 070113.doc <br />