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K1 FF H Analytical LLC SRG#: Project ID: 0 0 SAMPLE REECEIPT CHECKLIST 1 770`333 Date: _�AaASetn Ni ry RECEIVER Initials � COC Inspection Coolant Present: XLYes ❑ No (includes water) Temperature OC 3•f0 Therm. ID# __r9—Z Initial DatwTime Is COC present? ® Yes ❑ No Custody seals on shipping container? Intact ❑ Broken ❑ Not present ;,N/A Is COC Signed by Relinquisher? Nf 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 uninitialed cross -outs? Yes ❑ No, Whiteout ❑ No, Cross -outs Sample Inspection Coolant Present: XLYes ❑ No (includes water) Temperature OC 3•f0 Therm. ID# __r9—Z Initial DatwTime llf5 ❑N/A Are there custody seals on sample containers? ❑ Intact ❑ Broken Not present Do containers match COC? NYes ❑ 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? ❑ 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 Are the correct sample containers used for the analyses requested? Yes ❑ 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 Z No Receipt Details Matrixes Container type A 67MA_ # of containers received 3 Matrix Container type # of containers received Matrix Container type # of containers received Date and Time Sample Put into Temp Storage Date: 11120 0j Time: 1(0 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 containers, do they all match? JRYes SNo ❑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 ONO ❑ N/A Are the sample collection dates indicated: ❑ On COC ❑ On sample container(s) co On Both ❑ Not indicated If collection dates are listed on both COC and containers, do they all match? cE]-Yes ❑, ❑ N/A Are the sample collection times indicated: ❑ On COC E]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:Ud ed\s=precToms\S=ple Receipt Checklist rev 051409doc Page 10 of 10