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PSI FF � RECEIVER Analytical LLC SA LEE RECEIPT CHECKLIST O 3� S 12 Initials SRG#: > 05 I Date: Project ID: qo Lorer)7_o L.tw1bel" Method of Receipt: El Courier ver-the-counter Shipper COC Inspection Is COC present? XPfes ❑No Custody seals on shipping container? ❑Intact [-]Broken ❑Not present ( J/A Is COC Signed by Relinquisher? Wes E]No Dated? TYes es No (� Is sampler name legibly indicated on OC? oIs analysis or hold requested for all samples? es No Is the turnaround time indicated on COC? ❑Yes A No Is COC free of whiteout and uninitialed cross-outs? ❑Yes ❑No,Whiteout PNo,Cross-outs Sample Inspection Coolant Present: p Yeso includes watrg ) J // Temperature°C Therm.ID# Initial Date/Time l�305)2/ I F�27❑N/A Are there custody seals on sample containers? ❑Intact ❑Broken JyNot present Do containers match COC? Yes ❑No [:)No,COC lists absent sample(s) ❑No,Extra sample(s)present Are there samples matrices otlk than soil,water,air or carbon? ❑Yeso Are any sample containers broken,leaking or damaged? E]Yes No Are preservatives indicated? E]Yes,on sample containers 123yes, on COC ❑Not indicated ❑N/A Are preservatives correct for analyses requested? tes es El No [_1 N/A Are samples within holding time for analyses requested? es E]No Are the correct sample containers used for the analyses requested? es ❑No Is there sufficient sample to perform testing? ❑No Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes No Receipt Details Matrix Container types 01 y #of containers received Matrix Container type #of containers received¢ O Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Date: 0'305 I Z Time: uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) ®On Both ❑Not indicated If Sample ID's are listed on both COC and containers,do they all match? Yes [:]No ❑N/A Is the Project ID indicated: t 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 W N/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? Kyes 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 N No ❑N/A COMMENTS: NO I T on COC- Fye �IScrO oc No -m o m - L ° 3052 - 6 h., L's /vl` -oz 0 S S�. i suW�,L3- -0 3 6W VVA s _ 7 rA 2 172-7-- O:\old_edtsatnprec\Forms%=ple Receipt Checklist rev 051409.doc Page 41 of 41