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/RECEIVeR KJFF O SAMPLE RECEIPT CHECKLIST D Initlats SRG#: n O S Daze• nO S I Project ID: I l b O O ct r I4 YJ R d Method of Receipt: Courier Over-the-counter Shipper COC Inspection ❑ Is COC present? 9Yes No Custody seals on shipping container? ❑Intact ❑Broken ❑Not present �I/A Is COC Signed by Relinquisher? O Yes ❑No Dated? es No / Is sampler name legibly indicated on COC? Yes No Is analysis or hold requested for all samples? Yes ❑No Is the turnaround time indicated on COC? Yes ❑No Is COC free of whiteout and uninitiated cross-outs? "'❑❑❑Yes ❑No, Whiteout P No,Cross-outs Sample Inspection Coolant Present: Yes o includes wa ) Temperature°C�_Therm.ID# N Initial t Date/Time /)305)2/ /62Z[]N/A Are there custody seals on sample containers? ❑Intact ❑Broken Not present Do containers match COC? ( Yes ❑No ❑No,COC lists absent sample(s) ❑No,Extra sample(s)present Are there samples matrices othet than soil,water,air or carbon? ❑Yes No Are any sample containers broken,leaking or damaged? ❑Yes RNo Are preservatives indicated? ❑Yes,on sample containers ❑Yes,on COC Not indicated V N/A Are preservatives correct for analyses requested? ❑Yes ❑No WNIA 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 s petted to be hot? ❑Yes No Receipt Details Matrix _ Container type If P� #of containers received Matrix Container type #of containers received Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Date: 9 S O,S) Z Time: 14:3o Quicklolz Are the Sample ID's indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated If Sample ID's aro listed on both COC and containers,do they all match? ®Yes E]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 [AN/A Are the sample collection dates indicated: ❑On'COC ❑On sample container(s) ®On Both ❑Not indicated If collection dates are listed on both COC and containers,do they all match? [ Yes No E]N/A Are the sample collection times indicated: ❑On COC ❑On sample containers) On Both ❑Not indicated 117-collection times are listed on both COC and containers,do they all match? 33Yes 1 No ❑N/A C COMMENTS: Fuel 0X,/ 'S C 2"W✓I C y^ O ✓bl e ftoo O rhe Isms O:\old_ed\s prcc\Fo s\S=ple Rcmipt Checklist t 051409.dm Page 29 of 29