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KI FF <br /> Analytical LLC SAMPLE ftECEIPT CHECKLIST nasals <br /> SRG#: Z Date: <br /> Project ID: Q C5q 5 ✓ 0V A l <br /> Method of Receipt: Courier Over-the-counter Shipper <br /> COC Inspection <br /> Is COC present? fates ❑No <br /> Custody seals on shipping container? ❑Intact []Broken ❑Not presegyPd31/A <br /> Is COC Signed by Relinquisher? §Yes ❑No Dated? QtYes ❑No <br /> Is sampler name legibly indicated oni:OC? t9yes ❑No <br /> Is analysis or hold requested for all samples Yes ❑No <br /> Is the turnaround time indicated on COC? Yes [:]No <br /> Is COC free of whiteout and uninitiated cross-outs? ❑Yes ❑No, Whiteout 15a�No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: -St[Wes Q No includes water) <br /> Temperature°C ✓ Therm. ID# � — Initial Date/Time �� ���ISSo ❑N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken TS.Not present <br /> Do containers match COC? Yes ❑No ❑No,COC lists absent sample(s) ❑No, Extra sample(s)present <br /> Are there samples matrices other than soil,water,air or carbon? ❑YesNo <br /> Are any sample containers broken, leaking or damaged? ❑Yes No <br /> Are preservatives indicated? [—]Yes,on sample containers ❑Yes,on COC ❑Not indicatedN/A <br /> Are preservatives correct for analyses requested? ❑Yes ❑No 9N/A <br /> Are samples within holding time for analyses requested? Yes ❑No <br /> Are the correct sample containers used for the analyses requested? Yes ❑No <br /> Is there sufficient sample to perform testing? Yes ❑No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑YesJo <br /> Receipt Details <br /> Matrix SO Container type s k-e� #of containers received <br /> Matrix Container type #of containers received <br /> Matrix Container type of containers received <br /> Date and Time Sample Put into Temp Storage�3� Time: ) Ss D <br /> Ouickloiz <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) n Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? 19Yes ❑No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) ,P�On Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? R'Yes ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) � Both ❑Not indicated <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: L]On COC F]On sample container(s) ❑❑On Both Not indicated <br /> If collection times are listed on both COC and containers,do they all match? ❑Yes ❑No AN/A <br /> COMMENTS: <br /> 0 Wd_ed'sarnprecTurris\Sample Receipt Checklist rev 051409.dm <br /> Page 33 of 33 <br />