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K1 FF RE�E>a Analvtical LLc SAMPLE RECEIPT CHECKLIST Inditiair SRG#: 1 SS1 Date: O7-0 6 f Z Project ID: Ab , L�� f SRC :'V./ Method of Receipt: b4 Courier LJ Over-the-counter Shipper COC Inspection Is COC present? Q'Yes ❑ No Custody seals on shipping container?Intact V9 sampler ❑ Broken E] Not present 1K NIA ❑ No Is COC Signed by Rel inquisher? Yes ❑ No COC? Dated? Yes Are preservatives indicated? ❑ Yes, on sample containers ❑ Yes, on COC Is name legibly indicated on mYes ❑ No Is analysis or hold requested for all samples? X Yes ❑ No Is the turnaround time indicated on COC? 9 Yes ❑ No Is COC free of whiteout and uninitiated cross -outs? ® Yes ❑ No, Whiteout ❑ No, Cross -outs Sample Inspection Coolant Present: Yes ❑ NoIincludes water -- b'B Date/Time_ OlD612-/ g 3 5 ❑ NIA Temperature °C Z, 6 Therm. ID# `f' Initial_ Are there custody seals on sample containers? ❑ Intact ❑ Broken K) Not present Do containers match COC? Dg Yes ❑ 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 indicatedN/A Are preservatives correct for analyses requested? EJYes E]No N/A Are samples within holding time for analyses requested? 0 Yes ❑ No Are the correct sample containers used for the analyses requested? FQ Yes 0 No Is there sufficient sample to perform testing? es ❑ No Does any sample contain product, have strong odor or are otherwise suspected to be hot? ❑ Yes o Receipt Details Matrixes Container type # of containers received t S Matrix Container type # of containers received Matrix Container type # of containers received Date and Time Sample Put into Temp Storage Date: 01-p (o I Z Time: i61441 uicklo Are the Sample ID's indicated: ❑ On COC ❑ On sample contai r(s)On Both L]Not indicated If Sample ID's are listed on both COC and containers, do they all match? es No F] NIA Is the Project ID indicated: ❑ On COC E] On sample container(s) On Both ❑ Not indicated If project ID is listed on both COC and containers, do they all match? \0e Yes E] No EJ N/A F]❑ Are the sample collection dates indicated: On COC On sam lcontainer(s) On Both ❑ Not indicated If collection dates are listed on both COC and containers, do they all match? 60Yes ❑ No ❑ N/A Are the sample collection times indicated: ❑ On COC ❑ On sample contai er(s) 0 O Both ❑ Not indicated If collection times are listed on both COC and containers, do they all match? Q�Yes ❑ No ❑ N/A COMMENTS: 0Ao1d_ed\samprec\Fomzs\Sample Receipt Checklist rev 051409.doc Page 18 of 18