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K'FF RECEIVER Analytical LLL SAMPLE RECEIPT CHECKLIST Initia s SRG#: +p4i3 l¢3 5 Date: 12-2-11?-- Project 2Zf1ZProject ID: T��L'2` 7A Method of Receipt: ❑Courier ;!9;0ver-the-counter ❑Shipper Shipping Only: ❑FedEx* ❑OnTrac* ❑Greyhound ❑Other *Service level if not Priority or Sunrise(M-F): COC Inspection Is COC present? Vf Yes ❑No Custody seals on shipping container? 0 Intact ❑Broken ❑Not present-SIv/A Is COC Signed by Relinquisher? gYes ❑No Dated? K Yes ❑No Is sampler name legibly indicated on COC? res E]No Is analysis or hold requested for all samples? Yes ❑No Is the turnaround time indicated on COC? Wes ❑No Is COC free of whiteout and uninitialed cross-outs? ❑Yes ❑No,Whiteout 4No,Cross-outs Sample Inspection Coolant Present: Yes 4 No(includes water) O I.AM2 Temperature°C��_Therm. Initial yy%..l'4 Date/Time Z- ❑N/A Are there custody seals on sample containers? ❑Intact ❑Broken R Not present Do containers match COC? ;K Yes ❑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? KYes,on sample containers ❑Yes,on COC ❑Not indicated ❑N/A Are preservatives correct for analyses requested? J,Yes ❑No ❑N/A Are samples within holding time for analyses requested? MYes ❑No Are the correct sample containers used for the analyses requested? gYes ❑No Is there sufficient sample to perform testing? Wyes ❑No Does any sample contain product,have strong odor or are otherwise sus ected to be hot? ❑Yes 54No Receipt Details Matrix Container type 60, #of containers received 2 Matrix Wit Container type #of containers received Matrix �iy�� Container typer' #of containers received Date and Time Sample Put into Temp Storage Date: Time: 1.5177 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 cont finers,do they all match? r rYes ❑No E]N/A Is the Project ID indicated: On COC ❑On sample container(s) ❑On Both ❑Not indicated If project ID is listed on both COC and containers,do they all match? ❑Yes ❑No KN/A Are the sample collection dates indicated: ❑On COC ❑On sample container(s) n Both ❑Not indicated If collection dates are listed on both COC and containers,do they all match? PKYes �o ❑N/A Are the sample collection times indicated: ❑On COC ❑On sample container ) �On Both ❑Not indicated If collection times are listed on both COC and containers,do they all match? K'es ❑No ❑N/A COMMENTS: O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 072412.doc Page 24 of 24