Laserfiche WebLink
Kl FF RECEIVER <br /> Analvtica!LLC SAMPLE RECEIPT CHECKLIST <br /> Initials <br /> SRG#: 44 O Date: 111410 <br /> Project ID: <br /> Method of Receipt: Courier El Over-the-counter Shipper <br /> COC Inspection <br /> Is COC present? des ❑No <br /> Custody seals on shipping container? ❑Intact ❑Broken ❑Not present J Fl <br /> Is COC Signed by Relinquisher? r'Ycs ❑No Dated? ❑No <br /> Is sampler name legibly indicated on COC? res EJNo <br /> Is analysis or hold requested for all samples ❑No <br /> Is the turnaround time indicated on COC? ❑Yes 4&k <br /> Is COC free of whiteout and uninitialed cross-outs? ❑Yes ❑No,Whiteout Alko,Cross-outs <br /> Sample Inspection <br /> Coolant Present: ❑Yes @No(includes water) <br /> Temperature°C Therm. ID# Initial Date/Time O<A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken F%ot present <br /> Do containers match COC? &►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 &Io <br /> Are any sample containers broken,leaking or damaged? ❑Yes D�UQ <br /> Are preservatives indicated? ❑Yes,on sample containers ❑Yes,on COC ❑Not indicated,&N/A <br /> Are preservatives correct for analyses requested? ❑Yes ❑No BILA <br /> Are samples within holding time for analyses requested? @! Ves ❑No <br /> Are the correct sample containers used for the analyses requested? gYes ❑No <br /> Is there sufficient sample to perform testing? @94es ❑No <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yesio <br /> Receipt a.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: /�� ( _Time: <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) J40n Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? Q Pres ❑No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) Jj4Dn Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? (KYes ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample contain r(s) J59n Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? s ❑No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) (2110n Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? CZ-Ves ❑No ❑N/A <br /> COMMENTS: <br /> O:\old_edlsampreclFormslSample Receipt Checklist rev 051409.doc <br /> Page 6 of 6 <br />