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SAF-RC-047 100 & 300 Area Component of the ... - Hanford Site

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^\<br />

CLIENT: —Y-VW<br />

Lionvi ll<br />

e Laboratory Incorporated<br />

SAMPLE RECEIPT CRECKLIST (S<strong>RC</strong>)<br />

(<br />

r<br />

Yurchs^e Order / Project# / C y<br />

/ W# / Release #: R<br />

n<br />

\iCiN-J- t3^ Date:<br />

Batch # : ?^ , 1 • Sample Custodian:<br />

1. Samples Hand De livered w Shipped<br />

2. Custody seals on coolers or shipping<br />

container intact, signed and dated?<br />

NOTE:<br />

3. Outside <strong>of</strong> coolers or shipping containe rs are<br />

free from damage?<br />

4. All expected paperwork received (coo and<br />

o<strong>the</strong>r c lient speci fic information) sealed in<br />

plastic bag and easily access ible?<br />

5. Samples receiv cool ambient? yQ<br />

6. Custody seals on sample containers intact<br />

signed and dated?<br />

7. coc signed and dated?<br />

8_ Sample containers are inta ct?<br />

9. All samples on coc received? A ll samples<br />

received on coc?<br />

10. Ali<br />

label information matches coc?<br />

11. Samples properly preserved?<br />

12. Samples received within hold times?<br />

Short holds taken to wet lab?<br />

SR-002-11<br />

13. VOA, TOC, TOX free <strong>of</strong> headspace?<br />

14. QC stickers placed on bottles designated by<br />

client?<br />

15. Shipment meets LvLI Sample Acceptance<br />

Policy? (Identify a ll bottles not within<br />

policy. See reverse side for policy)<br />

16. Project Manager contacted concerning<br />

discrepancies? nameldste (or samples<br />

outside criteria)<br />

vLl<br />

N ALL DISCREPk<br />

-e. so<br />

/<br />

l 4" O Ne<br />

P<br />

TT7<br />

Yes O No<br />

a O No<br />

emp —j-'J °C<br />

Yes O No<br />

ra<br />

Ya<br />

Y<br />

/ es<br />

I9(Yes<br />

)dyes<br />

Yes<br />

O Ya<br />

O Ycs<br />

O Yes<br />

6]"Yes<br />

O No<br />

ONO<br />

O No<br />

O No<br />

0 No<br />

O No<br />

ONO<br />

Airb ill# 701 27<br />

O No Seals Comments<br />

o15O'J 7<br />

Cooler# SANS-\^3<br />

O No Seals<br />

^N/A<br />

ONO n,(/A<br />

ONo<br />

44<br />

P.= 3<br />

0 N No<br />

Discrepancies<br />

000000053

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