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Kl FF RECEIVER Ana►vt►ca►u.c SAMPLE RECEIPT CHECKLIST Ini1 tials SRG#: `� '& Z-q&o Date: Project ID: 4QU?_ %UON,-6j-iyt,, dc4a �u,�p�ivr� �Vc�Zz� Method of Receipt: ❑Courier Wver-the-counter ❑Shipper Shipping Only: ❑FedEx* ❑OnTrac* ❑Greyhound ❑Other *Service level if not Priority or Sunrise(M-F): COC Inspection Is COC present? rRYes ❑No Custody seals on shipping container? ❑Intact ❑Broken ❑Not present ®N/A Is COC Signed by Relinquisher? E[Yes ❑No Dated? K Yes ❑No Is sampler name legibly indicated on COC? ®Yes ❑No Is analysis or hold requested for all samples? Z Yes ❑No Is the turnaround time indicated on COC? K Yes ❑No Is COC free of whiteout and uninitialed cross-outs? ❑Yes ❑No,Whiteout X No,Cross-outs Sample Inspection Coolant Present: Yes ❑No(includes water) Temperature°C 3. 4' berm.ID# _TP_-3 Initial Date/Time 101 112A-4oo ❑N/A Are there custody seals on sample containers? ❑Intact ❑Broken ®Not present Do containers match COC? ayes ❑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 ZNo Are preservatives indicated? ❑Yes,on sample containers R Yes,on COC ❑Not indicated ❑N/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? KYes ❑No Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes MNo Receipt Details Matrix Container type \J D.� #of containers received 2-02— Matrix © LMatrix Container type #of containers received Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Date: IU I-�1Z Time: 1 C j Quickloiz Are the Sample ID's indicated: ❑On COC ❑On sample container(s) 150n Both ❑Not indicated If Sample ID's are listed on both COC and containers,do they all match? 'Yes ❑No ❑N/A Is the Project ID indicated: ❑On COC ❑On sample container(s),,P�'On Both ❑Not indicated If project ID is listed on both COC and containers,do they all match? es E]No ❑N/A Are the sample collection dates indicated: E]On COC ❑On sample cont 'ner(s)__,®On Both ❑Not indicated If collection dates are listed on both COC and containers,do they all match? Poyes ❑No ❑N/A Are the sample collection times indicated: ❑On COC ❑On sample container(s) 29 On Both ❑Not indicated If collection times are listed on both COC and containers,do they all match? ZYes/❑No F]N/A COMMENTS: PAG` C5 2O:\o ( oi-712- Wold ed\sarnprec\Forrns\SarnpIe lded\samprec\Forms\Sample Receipt Checklist rev 072412.doc Page 73 of 73