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KIFF0 RECEIVER <br /> Analvtical LLC SAMPLE RECEIP CHECKLIST m; <br /> SRG#: Date: <br /> T <br /> Project ID: A <br /> Method of Receipt: Courier Fn Over-the-counter ❑Shipper <br /> COC Inspection <br /> Is COC present? Yes ❑No <br /> Custody seals on shipping container? ❑Intact ❑Broken ❑Not present UfN/A <br /> Is COC Signed by Relinquisher? /ZYes ❑No Dated? ZYes E]No <br /> Is sampler name legibly indicated on COC? Zryes ❑No <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 ONo,Cross-outs <br /> Sample Inspection <br /> Coolant Present: „0Yes ❑No(includes water <br /> Temperature°CTherm. ID#I�2—Initial Date/Time-1(1710 073 E]N/A <br /> Are there custody seals on sample containers? Intact ❑Broken Not present <br /> Do containers match COC? ZfYes ❑No ❑No,COC lists absent sample(s) No,Extra sample(s)present <br /> Are there samples matrices other than soil,water,air or carbon? ❑YesNo <br /> Are any sample containers broken, leaking or damaged? F-1Yes o <br /> Are preservatives indicated? ZYes,on sample containers ❑Yes,on COC Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? Yes F]No ❑N/A <br /> 4 <br /> Are samples within holding time for analyses requested? 4Yes E]No <br /> Are the correct sample containers used for the analyses requested? Yes �/ ❑N <br /> Is there sufficient sample to perform testing? es a <br /> Does any sample contain product,have strong odor or are otherwise suspected to be hot? ❑Yes No <br /> Receipt Det is <br /> Matrix Container type dlBu #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: ] l 1Cs Time: G77 <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) On Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? [ Yes MNo ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) -M On Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? XYes ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) 00n Both ❑Not indicated <br /> If collection dates are listed on both COC and containers,do they all match? ;R Yes ❑No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) ,K On Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? INYe ❑No ❑N/A <br /> COMMENTS: ,� C,_� ]CI <br /> , 4 <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 23 of 23 <br />