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1<1FF0 4 <br /> Analvtical LLC SAMPLE RECEIPT CHECKLIST 072-,0 <br /> � ( � Initials <br /> SRG#: 7�J^�^Z2 DlIate: l <br /> Project ID: ,1 O M O,1, -f—or () q lj C 1 <br /> Method of Receipt: ourier Over-the-counter Jbipper <br /> COC Inspection <br /> Is COC present? les <br /> es E]No <br /> Custody seals on shipping container? tact ❑Broken ❑Not present DO/A <br /> Is COC Signed by Relinquisher? �'es F-1NoDated? es E]No <br /> Is sampler name legibly indicated on COC? es E]No <br /> Is analysis or hold requested for all samples ❑No <br /> Is the turnaround time indicated on COC? 'Uf Yes E]No <br /> Is COC free of whiteout and uninitialed cross-outs? ❑Yes ❑No, Whiteout 1214o,Cross-outs <br /> Sample Inspection <br /> Coolant Present: Yes E]` No(includes water) ��i <br /> Temperature°C O Therm. ID# rR_5Initial iW � Date/Time 0 7� IQ <br /> N/A <br /> Are there custody seals on sample containers? ❑Intact ❑Broken Not present <br /> Do containers match COC? 'Q 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 o <br /> Are any sample containers broken, leaking or damaged? ❑Yes No <br /> Are preservatives indicated? ❑Yes,on sample containers Da Yes,on COC ❑Not indicated ❑N/A <br /> Are preservatives correct for analyses requested? 153Yes ❑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 su ected to be hot? ❑Yes _oNo <br /> Receipt Details < <br /> Matrix Container type \!o /I #of containers received J <br /> Matrix Container type q � #of containers received <br /> Matrix Container type— #of containers received_ <br /> Date and Time Sample Put into Temp Stora a Date: 0_77?-0 1 O Time:_101Iq <br /> uicklo <br /> Are the Sample ID's indicated: ❑On COC ❑On sample container(s) (c On Both ❑Not indicated <br /> If Sample ID's are listed on both COC and containers,do they all match? t'r!IYes ❑No ❑N/A <br /> Is the Project ID indicated: ❑On COC ❑On sample container(s) C&Dn Both ❑Not indicated <br /> If project ID is listed on both COC and containers,do they all match? Ptes ❑No ❑N/A <br /> Are the sample collection dates indicated: ❑On COC ❑On sample container(s) gKOn Both ❑Not indicated <br /> If collection dates are listed on both COC and containers, do they all match? des ❑No ❑N/A <br /> Are the sample collection times indicated: ❑On COC ❑On sample container(s) &rOn Both ❑Not indicated <br /> If collection times are listed on both COC and containers,do they all match? d—yes ❑No ❑N/A <br /> COMMENTS: <br /> O:\old_ed\samprec\Forms\Sample Receipt Checklist rev 051409.doc <br /> Page 205 of 205 <br />