Laserfiche WebLink
KIFFO RECEIVER <br /> Analvtkal LLC SAMPLE RECEIPT CHECKLISTp D <br /> t/ Date: <br /> SRG#: 7 (0 C1 l 'D <br /> Project ID: <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 ❑Broken ❑Not present ❑N/A <br /> Is COC Signed by Relinquisher? D*Yes E]No Dated? Yes [—]No <br /> Is sampler name legibly indicated on OC? NYes MNo <br /> Is analysis or hold requested for all samplesYes ❑No <br /> Is the turnaround time indicated on COC? Yes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? Yes ❑No, Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: / MYes ❑No(includes water) p/ 2 3 <br /> Temperature°C '© Therm. ID# r-- — Initial�Date/Timed 2� ( E]N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken (jNot present <br /> Do containers match COC? %Yes ❑No ❑No,COC lists absent sample(s) ❑No,Extra sam¢l`e'(s)present <br /> Are there samples matrices other than soil,water,air or carbon? ❑Yes fZNo <br /> Are any sample containers broken,leaking or damaged? ❑Yes o <br /> Are preservatives indicated? es,on sample containers ❑Yes,on COC RNot indicated ❑N/A <br /> Are preservatives correct for analys6s 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 `r <br /> Matrix Container type V #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: 00q l ZY i o Time: 11 7=S <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) 0On Both E]Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? W[Yes F]No F]N/A <br /> E]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? 10 Yes ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? P Yes No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) JK On 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 18 of 25 Page 10 of 10 <br />