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

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1_ Samples Hand Delivered orhippe<br />

Lionville Laboratory Incorporated<br />

SAMTLE RECEIPT CHECKLIST (S<strong>RC</strong>)<br />

CLIENT:-T ISU VA4r-,Coe- P Date: 4- la• d-<br />

P chase Order/ Project# / R C.O+-4'7<br />

CAF#' SOW#/Release#:<br />

LvLI Batch 9 : h ` 1 —7 ^ Sample Custodian:<br />

2. Custody seals on coole rs or shipping<br />

container intact, signed and dated?<br />

l 1 t n f Y^L I GJIJ<br />

NOTE: EXPLAIN ALL DISCREPANCIES /<br />

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

free from damage?<br />

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

o<strong>the</strong>r client specific information) sealed in<br />

plastic bag and easily accessible?<br />

5. Samples receiver ambient?<br />

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

signed and dated?<br />

7. coc signed and dated?<br />

3. Sample containers are intact?<br />

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

received on coc?<br />

10. All sample label information matches coc?<br />

11. Samples properly preserved?<br />

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

Short holds taken to wet lab?<br />

a-M-B<br />

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

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

client?<br />

13. Shipment meets LvLI Sample Acceptance<br />

Po licy? (Identify all bottles cot within<br />

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

16. Project Manager contacted concerning<br />

discrepancies? nameldate (or samples<br />

outside criteria)<br />

^Lr<br />

Airbili# —IgD3 169-11 -)- 1-q<br />

G(Yes ONO O No Seals Comments<br />

VYes ONO<br />

IXYes O No<br />

Temp ^.8 OC Cooler # F—K4 'Oa • 4

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