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KI�FFH <br />Analvical LLC <br />SRG#: <br />Project ID: <br />0 <br />SAE,, RECEIPT CHECKLIST <br />Date: MIZvq <br />Nlc+dseM S�,r15 Dui U <br />Recerv¢a <br />r56 <br />COC Inspection <br />Yes <br />❑ No <br />Is COC present? <br />Custody seals on shipping container? <br />❑ Intact <br />❑ Broken ❑ Not present,&N/A <br />Is COC Signed by Relinquisher? %Yes ❑ No <br />Dated?Yes <br />Yes <br />E] No <br />❑ No <br />is sampler name legibly indicated on COC? <br />Yes <br />❑ No <br />Is analysis or hold requested for all samples <br />E Yes <br />❑ No <br />Is the turnaround time indicated on COC? <br />Is COC free of whiteout and uninitiated cross -outs? <br />RqYes <br />❑No, Whiteout [:]No, Cross -outs <br />Sample Inspection <br />Coolant Present: XYes ❑ No (includes water <br />2 Date/Time <br />' 12C s ❑ N/A <br />Temperature °C 3. (O Therm. ID# S� <br />Are there custody seals on sample containers? <br />Initial <br />❑ Intact <br />❑Broken Not present <br />t h COC? rZ Yes ❑ No ❑ No <br />COC lists absent samples) <br />❑ No, Extra sample(s) present <br />Do containers mac <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 />❑ Yes, on COC <br />No <br />[]Not indicated N/A <br />Are preservatives indicated? ❑ Yes, on sample containers <br />Yes <br />❑ No ® N/A <br />Are preservatives correct for analyses requested? <br />Yes <br />❑ No <br />Are samples within holding time for analyses requested? <br />® Yes <br />❑ No <br />Are the correct sample containers used for the analyses requested? <br />Is there sufficient sample to perform testing? mYes <br />contain have strong odor or are otherwise suspected to be hot? <br />❑ No <br />❑ Yes ANo <br />Does any sample product, <br />Receipt Details <br />Matrlx_-'—;l7 Container type(5 2W -k- # of containers received <br />8 <br />Matrix Container type # of containers received <br />Matrix Container type# of containers received <br />III 2 d 4� Time: <br />Date and Time Sample Put into Temp Storage Date: <br />uicklo <br />Are the Sample ID's indicated: ❑ On COC ❑ On sample container(s) 250n Both []Not indicated <br />if Sample ID's are listed on both COC and containers, do they all match? XYes ❑ No ❑ N/A <br />Is the Project ID indicated: ❑ On COC ❑ On sample container(s) a0n Both ❑ Not indicated <br />If project ID is listed on both COC and containers, do they all match? ,Yes ❑ No❑ N/A <br />Are the sample collection dates indicated: ❑ On COC E] On sample container(s) On Both -]Notndicated <br />If collection dates are listed on both COC and containers, do they all match? ® Yes No ❑N/A <br />Are the sample collection times indicated: ❑ On COC ❑ On sample container(s) aOn Both ❑ Not indicated <br />If collection times are listed on both COC and containers, do they all match? [-Yes ❑ No ❑ N/A <br />CnMMENTS: <br />O:\old_ ed\sempmc\FomslS=ple Receipt Checklist rev 051409.doc <br />Page 8 of 8 <br />