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KIFFO RECEIVER <br /> Analvtical LLC SAMPLE RECEIPT CHECKLIST Initia� <br /> SRG#: Date: <br /> Project ID: <br /> Method of Receipt: 0 Courier Over-the-counter Shipper <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? ErYes ❑No Dated? es ❑No <br /> Is sampler name legibly indicated on COC? Yes ONo <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? Yes ❑No, Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: [ Yes N includes water) <br /> Temperature°C Therm. ID# Initial Date/Time (240/D I l 34 ❑N/A <br /> Are there custody seals on sample containers? Intact ❑Broken of present <br /> Do containers match COC? [ Yes ❑No ❑No,COC lists absent sample(s) M No,Extra sample(s)present <br /> Are there samples matrices other than soil,water,air or carbon? ❑Yeso <br /> Are any sample containers broken,leaking or damaged? E]Yes No <br /> Are preservatives indicated? [ Yes,on sample containers f'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? 12ryes ❑No <br /> Does any sample contain product,have strong dor or are otherwise suspected to be hot? ❑Yes KNo <br /> Receipt Deta 1 <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: 2ADL D Time: <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) �n Both El Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? Ozes ❑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? WYes ❑No ❑N/A <br /> Are the sample collection dates indicated: F-1OnCOC E]On sam le container(s) ON On Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? ❑YesNo E]N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? Pyes ❑No ❑N/A <br /> COMMENTS: 0IML <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 18 of 19 Page 17 of 17 <br />