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W <br />Login Sample Receipt Checklist <br />Client: Stantec Consulting Corp. Job Number: 320-24082-1 <br />Login Number: 24082 List Source: TestAmerica Sacramento <br />List Number: 1 <br />Creator: Hytrek, Cheryl <br />Question <br />Answer Comment <br />Radioactivity wasn't checked or is </= background as measured by a survey <br />True <br />meter. <br />The cooler's custody seal, if present, is intact. <br />N/A <br />Sample custody seals, if present, are intact. <br />N/A <br />The cooler or samples do not appear to have been compromised or <br />True <br />tampered with. <br />Samples were received on ice. <br />True <br />Cooler Temperature is acceptable. <br />True <br />Cooler Temperature is recorded. <br />True <br />COC is present. <br />True <br />COC is filled out in ink and legible. <br />True <br />COC is filled out with all pertinent information. <br />True <br />Is the Field Sampler's name present on COC? <br />True <br />There are no discrepancies between the containers received and the COC. <br />True <br />Samples are received within Holding Time (excluding tests with immediate <br />True <br />HTs) <br />Sample containers have legible labels. <br />True <br />Containers are not broken or leaking. <br />True <br />Sample collection date/times are provided. <br />True <br />Appropriate sample containers are used. <br />True <br />Sample bottles are completely filled. <br />True <br />Sample Preservation Verified. <br />N/A <br />There is sufficient vol. for all requested analyses, incl. any requested <br />True <br />MS/MS Ds <br />Containers requiring zero headspace have no headspace or bubble is <br />True <br /><6mm (1/4"). <br />Multiphasic samples are not present. <br />True <br />Samples do not require splitting or compositing. <br />True <br />Residual Chlorine Checked. <br />N/A <br />a <br />DEC 072016 <br />ENVIE'ONMIENTAL HEALTH <br />DEPARTMENT <br />TestAmerica Sacramento <br />Page 26 of 26 12/8/2016 <br />14 <br />