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RECEMR <br /> KIFF <br /> Analvtical ttc 0 SAMP E RECEIPT CHECKLIST <br /> SRG#: I ^I Date: l <br /> Project ID: °L _ C n <br /> Method of Receipt: Courier Over-the-counter ipper <br /> COC Inspection <br /> Is COC present? �Yes ❑No <br /> Custody seals on shipping container? ntact F-1Broken ❑Not present ❑N/A <br /> Is COC Signed by Relinquisher? Yes ❑No Dated? Yes ❑No <br /> 10 Is sampler name legibly indicated on EO-C? F-1 Yes No <br /> Is analysis or hold requested for all samples "Yes ❑No <br /> Is the turnaround time indicated on COC? Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? es ❑No,Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: Yes E]No(includes water) Og`� l D I <br /> Temperature°C r Therm.ID# =12—S Initial�ate/Time 1 j�( ❑N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken DeMot present <br /> Do containers match COC? 10)Yes ❑No ❑No, COC lists absent sample(s) ❑No,Extra sa ple(s)present <br /> Are there samples matrices other than soil,water,air or carbon? ❑YesNo <br /> Are any sample containers broken,leaking or damaged? ❑Yes No <br /> Are preservatives indicated? qples,on sample containers ❑Yes,on COC Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? J►Yes ❑No E]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? fl Yes ❑No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes No <br /> Receipt Details <br /> Matrix W� Container type #of containers received <br /> Matrix Container type #of containers received <br /> Matrix Container type #of containers rece'ved <br /> Date and Time Sample Put into Temp Storage Date: Q g� _Time: <br /> Q <br /> aicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) �<bn Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? es ❑No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? No ❑N/A <br /> Are the sample collection dates indicated: ElOn COC ❑On sam le container(s) On Both Not indicated <br /> If collection dates are listed on both COC and containers, do they all match? 1�dyes ❑No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) MOn 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 /> 0Ao1d_edlsampreclFormslSample Receipt Checklist rev 051409.doc <br /> Page 17 of 24 Page 9 of 9 <br />