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

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SR-002-B<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 LYLI Sample Acceptance<br />

Policy? (identify all bottles not within<br />

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

16. Project Manager contacted concerning<br />

discrepancies? name/date (or samples<br />

outside criteria)<br />

vLl<br />

Lionville Laboratory Incorporated<br />

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

r<br />

CLMNT: 'T^1U. ^r c- Date:<br />

MV,,/Beatch#:<br />

Order / Proj ect# / p<br />

OW# I Release #: R)c - p^^l<br />

C)(<br />

1. Samples Hand Delivered."r Shipped<br />

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

container intact, signed and dated?<br />

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

free from damage?<br />

4. All expe ct ed paperwork received (coc and<br />

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

plastic bag and easily acce ssible?<br />

o ^^L^ 1 Sample Custodian:<br />

NOTE: EXPLAIN ALL DISCREPANCIES<br />

S. Samples receiv cool r ambient? Z )<br />

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

signed and dated?<br />

7. coc signed and dated?<br />

a. Sample containers are intact?<br />

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

received on coc?<br />

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

11. Samples properly preserved?<br />

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

Short holds taken to wet lab?<br />

Sd Yes O No 17 No Seals<br />

res O No<br />

Jd Yes 0 N<br />

/O'-- ONo<br />

t(Yes O No<br />

Yes ONO<br />

lW<br />

J2(Ycs q No<br />

O Yes<br />

O Yes<br />

O Yes<br />

aYes<br />

• No IldN/A<br />

• No CIA<br />

0 N 11<br />

i er^F,.<br />

13 No<br />

Airbill# '7ga7 x565 1"<br />

[YYes O No O No Seals Comments<br />

//4 Yes q No<br />

7<br />

Yes O No<br />

Temp —T - 3 °C Cooler # SA LOS-1b_:^)<br />

ONO<br />

D'+satpaocics<br />

000000029

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