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MIFF H <br />AnalvLLC <br />SRG#: <br />Project ID: <br />Method <br />Is <br />0 <br />SAMPLE RECEIPT CHECKLIST <br />-RJ 6 59 Date: <br />MaL3etA S14flet.W_ Ni rt <br />REcEErmit <br />nitials <br />Tse) <br />COC Inspection <br />Coolant Present: K -Yes ❑ No (includes water) <br />Temperature°C 3•(0 Thetm.ID# -T-R-2-Initial -7;2F& Date/Time 111201 5757 E] N/A <br />Is COC present? <br />® Yes <br />❑ No <br />Custody seals on shipping container? <br />- Intact <br />❑ Broken ❑ Not present AN/A <br />Is COC Signed by Relinquisher? $J Yes ❑ No <br />Dated? Yes <br />❑ No <br />Is sampler name legibly indicated on COC? <br />Yes <br />❑ No <br />Is analysis or hold requested for all samples <br />Yes <br />❑ No <br />Is the turnaround time indicated on COC? <br />Yes <br />❑ No <br />Is COC free of whiteout and uninitialed cross -outs? <br />Yes <br />❑ No, Whiteout ❑ No, Cross -outs <br />Sample Inspection <br />Coolant Present: K -Yes ❑ No (includes water) <br />Temperature°C 3•(0 Thetm.ID# -T-R-2-Initial -7;2F& Date/Time 111201 5757 E] N/A <br />Are there custody seals on sample containers? ❑ Intact <br />❑ Broken KNot present <br />Do containers match COC? (,Yes ❑ No ❑ No, COC lists absent sample(s) <br />❑ No, Extra sample(s) present <br />Are there samples matrices other than soil, water, air or carbon? ❑ Yes <br />®No <br />Are any sample containers broken, leaking or damaged? ❑ Yes <br />®No <br />Are preservatives indicated? ❑ Yes, on sample containers ❑ Yes, on COC <br />❑ Not indicated N/A <br />Are preservatives correct for analyses requested? ❑ Yes <br />❑ No N/A <br />Are samples within holding time for analyses requested? ® Yes <br />❑ No <br />Are the correct sample containers used for the analyses requested?®_Yes <br />[-]No <br />Is there sufficient sample to perform testing? Yes <br />❑ No <br />Does any sample contain product, have strong odor or are otherwise suspected to be hot? <br />❑ Yes No <br />Receipt Details <br />Matrix__! o Container type $1 WA -k- # of containers received <br />3 <br />Matrix Container type # of containers received <br />Matrix Container type # of containers received <br />Date and Time Sample Put into Temp Storage Date: 1120 q Time: 1(0T <br />uicklo <br />Are the Sample ID's indicated: ❑ On COC ❑ On sample containers) <br />&OnBoth <br />❑ Not indicated <br />If Sample ID's are listed on both COC and containers, do they all match? JRYes <br />No <br />❑ N/A <br />Is the Project ID indicated: ❑ On COC ❑ On sample container(s) n Both ❑ Not indicated <br />If project ID is listed on both COC and containers, do they all match? -Yes ONo <br />❑ N/A <br />Are the sample collection dates indicated: ❑ On COC ❑ On sample container(s) <br />co On Both <br />❑ Not indicated <br />If collection dates are listed on both COC and containers, do they all match? c® -Yes <br />LJNo <br />❑ N/A <br />Are the sample collection times indicated: ❑ On COC ❑ On sample container(s)On <br />Both <br />E] Not indicated <br />If collection times are listed on both COC and containers, do they all match? Yes <br />No <br />❑ N/A <br />COMMENTS: <br />0:to1d_eAsWprecTonnsV9=p1e Receipt Checklist rev 05I409.dm <br />Page 10 of 10 <br />