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KI�FF H AnalvSRG#: Project ID: SAMPLE 2RECEIPT CHECKLIST J —70 O O Date: NMot—�3etA S�416s_ Ni rZ RECEIVER srI tials Method of Receipt: Courier JX Over-the-counter Shipper COC Inspection S�❑N/A Are there custody seals on sample containers? ❑ Intact Is COC present? ® Yes ❑ No Custody seals on shipping container? Intact ❑ Broken ❑ Not present XN/A Is COC Signed by Relinquisher? TO Yes ❑ No Dated?Yes ❑ No Is sampler name legibly indicated on COC? Yes ❑ No Is analysis or hold requested for all samples ® Yes ❑ No Is the turnaround time indicated on COC? ® Yes ❑ No Is COC free of whiteout and uninitiated cross -outs? Yes ❑ No, Whiteout ❑ No, Cross -outs Sample Inspection Coolant Present: FLYes ❑ No (includes water) Temperature OC 3-& Therm. ID# Initial Ts6 Date/Time �� I S�❑N/A Are there custody seals on sample containers? ❑ Intact ❑ Broken KNot present Do containers match COC? XYes ❑ 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 ❑ N/A Are any sample containers broken, leaking or damaged? ❑ Yes ®No Both Are preservatives indicated? ❑ Yes, on sample containers ❑ 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 No Are the correct sample containers used for the analyses requested?® Yes E]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 ERNo Receipt Details Matrix_eLO_ Container type 5:1 WAr-c- # of containers received 3 Matrix Container type # of containers received Matrix Container type # of containers received Date and Time Sample Put into Temp Storage DateTime: 1(n uicklo Are the Sample ID's indicated: ❑ On COC ❑ On sample container(s)On Both ElNot indicated If Sample ID's are listed on both COC and containers, do they all match? & Yes MNo ❑ N/A Is the Project ID indicated: ❑ On COC ❑ On sample container(s) n Both ❑ Not indicated If project ID is listed on both COC and containers, do they all match? -Yes LJ No ❑ N/A Are the sample collection dates indicated: ❑ On COC ❑ On sample container(s)On Both F] Not indicated If collection dates are listed on both COC and containers, do they all match? cf]-Yes � No ❑ N/A Are the sample collection times indicated: ❑ On COC ❑ On sample container(s) On Both [-]Not indicated If collection times are listed on both COC and containers, do they all match? Yes] No ❑ N/A COMMENTS: O:\old ed\s=prectForms\S=ple Receipt Checklist rev 051409.doc • • Page 10 of 10