Laserfiche WebLink
KIFF RECEIVER <br /> Analvtical LLC SAMPLE RECEIPT CHECKLIST Initials als <br /> SRG#: :2'3925Date: 07 2S/D <br /> Project ID: NksR+— 2,4 <br /> Method of Receipt: Courier ver-the-counter Shipper <br /> COC Inspection <br /> Is COC present? kYes ❑No <br /> Custody seals on shipping container? ❑Intact ❑Broken ❑Not present KN/A <br /> Is COC Signed by Relinquisher? U Yes ❑No Dated? Yes ❑No <br /> Is sampler name legibly indicated on COC? ❑Yes [ZNo <br /> Is analysis or hold requested for all samples Yes ❑No <br /> Is the turnaround time indicated on COC? ` J Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? 14Yes [:]No,Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: ( Yes ❑No(includes water) <br /> Temperature°C �J Therm. ID# T-a-Z. Initial vin,i9--> Date/Time ❑N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken �Iot present <br /> Do containers match COC? 'g 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? ❑Yes [gNo <br /> Are any sample containers broken,leaking or damaged? ❑Yes Y No <br /> Are preservatives indicated? ,Yes,on sample containers ❑Yes, on COC ❑Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? Yes ❑No ❑N/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? ❑Yes No <br /> Receipt Details p <br /> Matrix Container type 006 #of containers received 0 <br /> Matrix Container type #of containers received <br /> Matrix Container type #of containers received <br /> Date and Time Sample Put into Temp Storage Date: a"?'2gl Time: w <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) 90n Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? -I&Yes ❑ o ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) ,S9n Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? 'RYes []No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) .JEJOn 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: ❑On COC ❑On sample container(s) _PJtOn Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? Yes ❑No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 11 of 12 Page 10 of 10 <br />