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KIFF0 RECEIVER Analvtical LLC SAMPLE RECEIPT CHECKLIST Initials SRG#: rr,, 17 S 0 2 Date: I O Z o I Project ID: _t O D 'J 1+O f 1 ' Method of Receipt: �Soourier Over-the-counter 0 Shipper COC Inspection Is COC present? opyes ❑No �,.,,, Custody seals on shipping container? (❑Intact E]Broken ❑Not present JN/A Is COC Signed by Relinquisher? es E]No Dated? es E]No �� Is sampler name legibly indicated on OC? Yes ❑No Is analysis or hold requested for all samples Yes ❑No Is the turnaround time indicated on COC? Yes ❑No Is COC free of whiteout and uninitialed cross-outs? Yes ❑No,Whiteout o,Cross-outs Sample Inspection Coolant Present: Yes ❑No(includes water r0 20 )Q/ ❑N/A Temperature°C I �� Therm. ID#_ � 5 Initial Date/Time Are there custody seals on sample containers? ❑Intact ❑Broken Not present Do containers match COC? `SJ Yes ❑No ❑No,COC lists absent sample(s) ❑No,Extra sample(s)present Are there samples matrices other than soil,water, air or carbon? ❑YesNo Are any sample containers broken,leaking or damaged? El o Are preservatives indicated? ❑Yes,on sample containers Yes,on COC E7Not indicated [:]N/A Are preservatives correct for analyses requested? Yes ❑No ❑N/A Are samples within holding time for analyses requested? Yes ❑No Are the correct sample containers used for the analyses requested? Yes E]No Is there sufficient sample to perform testing? Yes E]Nod Does any sample contain product,have strong odor or are otherwise sus ected to be hot? ❑Yes Receipt Details Matrix Vv Container type a V� #of containers received �j Matrix Container type VO #of containers received ASO Matrix Container type #of containers receivyed Date and Time Sample Put into Temp Storage Date: (� Time: uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container(s) ;,SOOn Both ❑Not indicated If Sample ID's are listed on both COC and containers,do they all match? eKYes ❑No ❑N/A Is the Project ID indicated: ❑On COC ❑On sample container(s) nNn Both ❑Not indicated If project ID is listed on both COC and containers,do they all match? �3tes o ❑N/A Are the sample collection dates indicated: ❑On COC ❑On sample container(s On Both ❑Not indicated If collection dates are listed on both COC and containers, do they all match? <Yes No ❑N/A Are the sample collection times indicated: ❑On COC ❑On sample container(s) 6 On Both ❑Not indicated If collection times are listed on both COC and containers,do they all match? d_1Ff'es No ❑N/A COMMENTS: Wold_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc Page 168 of 168