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Date: KIFF H RECEIVER LLC SAMPLE CEIPT CHECKLIST SRG#: c 0 2- Project ID: Q C vv10V CI 1 Method of Receipt: Courier Over-the-counter Shipper COC Inspection Is COC present? 2rYes ❑No Custody seals on shipping container? ❑Intact ❑Broken ❑Not presegt�/A Is COC Signed by Relinquisher? JaYes ❑No Dated? Yes ❑No Is sampler name legibly indicated on'COC? es E]No Is analysis or hold requested for all samples Yes E]No Is the turnaround time indicated on COC? Yes ❑No Is COC free of whiteout and uninitialed cross-outs? ❑Yes ❑No, Whiteout Wo,Cross-outs Sam le Ins ection la Coont Present: 2[Wes No(includes water) nn Temperature°C - ✓ Therm.ID# r - Z, Initial Date/Time D J Oq fl/1550❑N/A Are there custody seals on sample containers? ❑Intact ❑Broken ' ,Not present Do containers match COC? PYes []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? ❑YesNo Are preservatives indicated? ❑Yes,on sample containers ❑Yes,on COC ❑Not indicated ®N/A Are preservatives correct for analyses requested? El Yes ❑No 5N/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 `allo Receipt Details Ip Matrix $O Container type s I`��- #of containers received Matrix Container type #of containers received Matrix Container type !/of containers received Date and Time Sample Put into Temp StorageDate c 304 LL_Time:1S O uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) An Both ❑Not indicated If Sample ID's are listed on both COC and containers,do they all match? 0-Yes ❑No ❑N/A 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? RYes ❑No ❑N/A Are the sample collection dates indicated: ❑On COC ❑On sample container(s) aOn Both []Not indicated If collection dates are listed on both COC and containers,do they all match? J2Yes ❑No ❑N/A Are the sample collection times indicated: ❑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 ON/A COMMENTS: 0:1okJ c&samprec\FormslSample Receipt Checklist my 051409.doc Page 33 of 33