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necetveR V Analwical LLC SAMPLE CEIPT CHECKLIST ta,,;atr SRG#: Date: 07230 Project ID: Method ofReceipt; M Courier Over-the-counter Whipper COC Inspection Is COC present? K'es ❑No Custody seals on shipping container? ❑Intact ❑Broken Not present d N/A Is COC Signed by Relinquisher? ,DYes E]No Dated? Yes E]No r Is sampler name legibly indicated on COC? -K Yes ❑NO: _. ;.• . 4 Is analysis or hold requested for all samples fayes ❑No ' Is the turnaround time indicated on COC? es ❑No Is COC free of whiteout and uninitiated cross-outs? es []No,Whiteout E]No,Cross-outs Sample lnsyection Coolant Present: PJYesNo includes water) .Oerm. Temperature°C_J ThID# �h InitialL ?_ Date/time D7290V 1 ❑N/A i Are there custody seals on sample containers? - - ❑intact. ❑Broken Mot present Do containers match COC? [ Yes ❑No ❑No,COC lists absent samples) ❑No,Extra sample(s)present Are there samples matrices other than soil,water,'air or carbon? ❑Yes 9 o Are any sample containers broken,leaking or damaged? ❑Yes ONO Are preservatives indicated? ❑Yes,on sample containers ❑Yes,on COC ❑Not indicated ®N/A F Are preservatives correct for analyses requested? [] ii ❑No ffV/A F Are samples within holding time ror analyses requested? es - EJ No Are the correct sample containers used for the analyses requested? as ❑No I Is there sufficient sample to perform testing? Yes j E]No Does any sample contain product,have strong odor or are otherwise suspected to be hot? '❑Yes �No Receipt Details Matrix S Container type e e v(! #of containers received Z Matrix Container'type #of containers received Matrix Container type #of containers receirf �_ Date and Time Sample Put into Temp Storage Date: '0 7?SO q Time: „ Y uickle Are the Sample ID's indicated; ❑On COC ❑On sample container(s) -Mn Both ❑Not indicated i If Sample ID's are listed on both COC and containers,do they all match? ❑No " El N/A Is the Project ID indicated: ❑On COC E]On sample container(s) Both ,,❑Not indicated If project ID is listed on both COC and containers, do they all match? ffves ❑No ?O N/A Are the sample collection dales indicated: ❑On COC ❑On sample container(s) ,Wn Both ❑Not indicated If collection dates are listed on both COC and containers,do they all match? {eV [�No ❑N/A Aro the sample collection Mimes indicated: ❑On COC C]On sample container s) 'B ❑Not indicated If collection times are listed on both COC and containers,do they all match? `J&Yes ❑No ❑N/A COMMENTS: . lg J z 0 l i f O:1otd_edlsamprec%Forms\Sample Receipt Checklist rev 051409.doc