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KIFFO RECEIVER Analvtical LLC SAMPLE RECEIPT CHECKLIST ,n;tff"l SRG#: 099/ Date: Project ID: L oto a"4_ Method of Receipt: Courier Over-the-counter Shipper COC Inspection Is COC present? Ig Yes ❑No Custody seals on shipping container? ❑Intact ❑Broken ❑Not present N/A Is COC Signed by Relinquisher? 54 Yes ❑No Dated? &]Yes ❑No Is sampler name legibly indicated on COC? NYes ❑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 No,Cross-outs Sample Inspection Coolant Present: Yes ❑No(includes water) p Temperature°C Therm. ID# Tib--7 Initial Date/Time � I (0 /:SLd E]N/A Are there custody seals on sample containers? ❑Intact ❑Broken 'Not present Do containers match COC? T9—yes ❑No ❑No,COC lists absent sample(s) ❑No,Extra sample(s)present Are there samples matrices other than soil,water,air or carbon? ❑Yes �No Are any sample containers broken,leaking or damaged? E]Yes No Are preservatives indicated? Yes,on sample containers Yes,on COC ❑Not 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 ❑No Is there sufficient sample to perform testing? Yes ❑No Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes XNo Receipt Details r Matrix Container type 0l #of containers received 6 Matrix_ Container type[ I©#of containers received Matrix Container type #of containers received Date and Time Sample Put into Temp Storage Date: 107-1 l c�Time: i uicklo Are the Sample ID's indicated: ❑On COC ❑On sample container ) �On Both ❑Not indicated If Sample ID's are listed on both COC and containers,do they all match? �'es ❑No ❑N/A Is the Project ID indicated: ❑On COC ❑On sample container(s) �On Both ❑Not indicated If project ID is listed on both COC and containers,do they all match? (2'Ytes []No ❑N/A Are the sample collection dates indicated: ❑On COC ❑On sample container(s) Tron Both ❑Not indicated If collection dates are listed on both COC and containers, do they all match? E4Y�es ❑No ❑N/A Are the sample collection times indicated: ❑On COC ❑On sample container(s) n Both E]Not indicated If collection times are listed on both COC and containers,do they all match? �es DNo ❑N/A COMMENTS: O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc Page 66 of 66