Laserfiche WebLink
K1 AnalvFF <br />SRG#: <br />Project ID: <br />Method <br />0 <br />0 <br />SAMPLE RECEIPT CHECKLIST <br />-709.39 Date: 111201 <br />AAA seAA 5vmrt--jA- 'ba-( ri <br />Courier <br />RECEIVER <br />T16 <br />COC Inspection <br />®No <br />Are preservatives indicated? ❑ Yes, on sample containers ❑ Yes, on COC <br />Is COC present? <br />KYes <br />❑ No <br />Custody seals on shipping container? <br />❑ Intact <br />❑ Broken ❑ Not present ZLN/A <br />Is COC Signed by Relinquisher? [KYes ❑ No <br />Dated? Yes <br />❑ No <br />Is sampler name legibly indicated on CDC?f <br />jl] 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 />2; Yes <br />❑ No, Whiteout ❑ No, Cross -outs <br />Samnle Inspection <br />Coolant Present: XYes ❑ No fincludes water <br />Temperature °C 3' TherS <br />. ID# IL— Initial6 Date/Time 12C%q 57 ❑N/A <br />Are there custody seals on sample containers? ❑ Intact E]Broken ffNot present <br />Do containers match COC? ZYes ❑ No []No, COC lists absent sample(s) ❑ No, Extra sample(s) present <br />Are there samples matrices other than soil water, air or carbon? ❑ YesNo <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? Eyes <br />❑ No <br />Does any sample contain product, have strong odor or are otherwise suspected to be hot? <br />❑ Yes ZNo <br />Receipt Details <br />Matrixes Container type(5 CWJL # of containers received <br />p <br />O <br />Matrix Container type # of containers received <br />El No <br />Matrix Container type # of containers received <br />Are the sample collection times indicated: ❑ On COC ❑ On sample container(s) <br />Date and Time Sample Put into Temp Storage Date: j 1 I Zd ok Time: I t6� <br />uicklo <br />Are the Sample ID's indicated: ❑ On COC ❑ On sample container(s) <br />P5,On Both <br />❑ Not indicated <br />If Sample ID's are listed on both COC and containers, do they all match? XYes <br />❑ No <br />❑ N/A <br />Is the Project ID indicated: ❑ On COC ❑ On sample container(s) aOn Both E3 Not indicated <br />If project ID is listed on both COC and containers, do they all match? ,Yes ❑ No <br />❑ N/A <br />Are the sample collection dates indicated: ❑ On COC ❑ On sample container(s) <br />54 On Both <br />❑ Not indicated <br />If collection dates are listed on both COC and containers, do they all match? W Yes <br />El No <br />❑ N/A <br />Are the sample collection times indicated: ❑ On COC ❑ On sample container(s) <br />[KOn Both <br />❑ Not indicated <br />If collection times are listed on both COC and containers, do they all match? [j}Yes <br />❑ No <br />❑ N/A <br />COMMENTS: <br />Wold_ edls=preclFo=slSample Receipt Checklist rcv 051409.doc <br />i <br />Page 8 of 8 <br />