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KIFF H R^v'a. Analytkal uc SAMPLE RECEIPT CHECKLIST — IniSd itis Date: D Project ID: C �Q \ J P C ^ q �ll !l[ 15 +w��vr-r ^A--t.S G4 Method of Receipt: Courier ter-the counter ❑Shipper rE naectton yCS ❑No present? ❑Intact ❑Broken ❑Not present�N/Ay seals on shipping container? ❑OC Signed by Relinquisheres ❑No Dated? 1 es Nompler name legibly indicated on COC? ❑No alysis or hold requested for all samples ,Ryes ❑Noe turnaround time indicated on COC? Is COC free of whiteout and uninitiated crosscuts? es El No,Whiteout E]No,Crosscuts rDocontainers nspection es No(includes water 1r� �� (j4D F esent: 15 2 --t'�y Initial, ___ Datelf ime �-�I q rr" `— ❑N/A re°C enn ID# {=—= ❑Intact ❑Broken QJot present ustody seals on sample containers. No,Extra sam I s went match COC? es ❑No ❑No,COC lists absent sample(s) ❑ P e( )Pr samples matrices other than soil,water,air or carbon? es ❑No Are any sample containers broken,leaking or damaged? Yes Are preservatives indicated? ❑Yes,on sample containers ❑Yes,on COC ❑moot indicated/AA Are preservatives correct for analyses requested? ❑Yes Are samples within holding time for analyses requested? .Yes ElNo Are the correct sample containers used for the analyses requested? �es []No No Is there sufficient sample to perform testing? es o Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes Receipt its ,Mix Container typey��_ #of containers received Matrix Container type #of containers received Matrix Containertype age Date: MCA of containers recei� Date and Time Sample Put into Temp Stor001 Time: ig u c On Both E]Not indicated Are the Sample ID's indicated: ❑On COC EJOn sample container(s) If Sample ID's are listed on both COC and containers,do they all match? Yes []No ❑N/A Is the Project ID indicated: ❑On COC ❑On sample container(s) ®On Both ❑Not indicated If project ID is listed on both COC and containers,do they all match? [@Yes []No Both Not indicated Oo sample container(s) ® ❑ Are the sample collection dates indicated: ❑On COC ❑ P If collection dates are listed on both COC and containers,do they all match? 'KYes ❑No ❑N/A Are the sample collection times indicated: ❑ E]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 E]N/A COMMENTS: �� M tMt w not nan.lee f 5- �_ -6 - Tip Ole) a 1 ^ pr KIK 13 .wF Ityt is I7 � y^"Q �p " CVG' �M,41MT 11 scif.� U -03 lrod(I44f P61 52 will o 5 iH `h S 'A hi.e4s aS _PM �(1CNt TG 1 w+olt�c..ltP Su (.e D/ t�45 (+n� l� etc- CO��-�ADsr�tf/ - S Of 41'7 O:bld_edarnp %Fa \Samplc Receipt Checklist m 051409.dm Page 3 of 3