Laserfiche WebLink
►<►FF RECEIVER <br /> Analvdcal LLC SAMPLECE�IPT CHECKLIST In <br /> SRG#: 7 bh�- Date: Q&e,/D <br /> Project ID: — <br /> Method of Receipt: Courier Over-the-counter 0 Shipper <br /> COC Inspection <br /> Is COC present? Ef-Yes ❑No <br /> Custody seals on shipping container? ❑Intact ❑Broken ❑Not present 2'h'I/A <br /> Is COC Signed by Relinquisher? Ef Yes ❑No Dated? Ods ❑No <br /> Is sampler name legibly indicated on COC? ❑Yes L2,f4o <br /> Is analysis or hold requested for all samples 2 Yes ❑No <br /> Is the turnaround time indicated on COC? les ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? es ❑No, Whiteout ❑No, Cross-outs <br /> Sample Inspection <br /> Coolant Present: ayes `�o(includes water, �0u0 � 01-E]N/A <br /> Temperature°C Therm. ID# ?i Initial Date/Time <br /> Are there custody seals on sample containers? ❑Intact ❑Broken [r]'Not present <br /> Do containers match COC? 21-es ❑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 B No <br /> Are any sample containers broken,leaking or damaged? ❑Yes EJ'No <br /> Are preservatives indicated? FI-Yes,on sample containers ❑Yes,on COC ❑Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? D Yes ❑No ❑N/A <br /> Are samples within holding time for analyses requested? 2Tes ❑No <br /> Are the correct sample containers used for the analyses requested? [les ❑No <br /> Is there sufficient sample to perform testing? E3-Yes ❑No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes ago <br /> Receipt D t ils 22 <br /> Matrix Container type #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 Date: 0��?j/ Time: <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) E!On Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? ['Yes ❑No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) 0 On Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? .eTYes EJNo [:]NIA <br /> Are the sample collection dates indicated: ❑On COC E]On sample container(s) QIOn 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) EOn Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? 2fes ❑No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 9 of 10 Page 8 of 8 <br />