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KIFF0 RECEIVER <br /> �6 <br /> Analytical LLC SAMPLE RECEIPT CHECKLIST Initials <br /> SRG#: 75 Date: Z_-2310 <br /> Project ID: APs e A <br /> Method of Receipt: Courier Over-the-counter Shipper <br /> COC Inspection <br /> Is COC present? Yes No <br /> Custody seals on shipping container? .91 <br /> 91 Intact ❑Broken ❑Not present ❑N/A <br /> Is COC Signed by Relinquisher? ;Yes ❑No Dated? Yes ❑No <br /> Is sampler name legibly indicated on COC? ❑Yes ®No <br /> Is analysis or hold requested for all samples ®Yes ❑No <br /> Is the turnaround time indicated on COC? Xyes ❑No <br /> Is COC free of whiteout and uninitialed cross-outs? Yes ❑No, Whiteout ❑No,Cross-outs <br /> Sample Inspection <br /> Coolant Present: EgYes ❑No(includes water) <br /> Temperature°C 1, 2 Therm. ID# 70-737-4 Initial -TJ-,g Date/Time I Z N/A <br /> Are there custody seals on sample containers? ❑Intact El X Not present <br /> Do containers match COC? D?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 No <br /> Are any sample containers broken, leaking or damaged? ❑Yes SNo <br /> Are preservatives indicated? N 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 Z No <br /> Receipt Details <br /> Matrix_ Container type_ #of containers received 2 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: 223(0 Time: _(2q6__ <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container s) [ n Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? nYes ❑No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) -B*O'n Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match?,ET-Yes ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) EJ'-0_n Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? 2r�es ❑N ❑N/A <br /> Are the sample collection times indicated: ❑On COC E] arlf On sample co iner(s) [] Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? 21es ❑No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprecTorms\Sample Receipt Checklist rev 051409.doc <br /> Page 14 of 15 Page 13 of 13 <br />