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2900 - Site Mitigation Program
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PR0524672
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/6/2020 10:11:48 AM
Creation date
2/6/2020 8:31:50 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0524672
PE
2965
FACILITY_ID
FA0016571
FACILITY_NAME
DEUEL VOCATIONAL INSTITUTE
STREET_NUMBER
23500
STREET_NAME
KASSON
STREET_TYPE
RD
City
TRACY
Zip
953049518
APN
23912001
CURRENT_STATUS
01
SITE_LOCATION
23500 KASSON RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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r <br /> SOP Volume: Client Services <br /> Section: 1.1.2 <br /> Page: 1 of I c Curtis&Tompkins.Ltd. <br /> C Effective Date: 10-May-99 <br /> Revision: 1 Number I of 3 <br /> Filename: F:\QC\Forms\QC\Cooler.wpd <br /> COOLER RECEIPT CHECKLIST <br /> Login#:—`� ,� �—�Date Received: 1-;t-05- Number of Coolers: I <br /> Client: V K 7 Project: D VI -5 T Py <br /> A. Preliminary Examination Phase <br /> P 9P (sign) !b yL <br /> slip <br /> lP( i 2 .......................................... NO <br /> Date opened: q•�- BY (print):)� <br /> l. Did cooler come with a shippingsli yV aubil , etc. .., t k $4 7014d03g�'g + <br /> If YES,enter carver name and airbill number: fd <br /> 2. Were custody seals on outside of cooler?......................................................... < ET9 NO <br /> How many and where? 1 ; K `11%& Seal date: 4'1 95 _Seal name: MA <br /> 3. Were custody seals unbroken and intact at the date and time of arrival?........... V2 NO <br /> 4. Were custody papers dry and intact when received?......................................... NO <br /> 5. Were custody papers filled out properly (ink, signed,etc.)?..............................Ov:�N NO <br /> 6. Did you sign the custody papers in the appropriate place?..............•.. ..............� NO <br /> 7. Was project identifiable from custody papers?............ .....<,�D NO <br /> If YES,enter project name at the top of this form. <br /> 8. If required,was sufficient ice used?Samples should be 2-6 degrees C. ............ 1'ES NO <br /> Type of ice: C_"P k Temperature: SS <br /> B. Login Phase 7 ,9 ( .g ) <br /> Date Logged In: `j.�_A 5_BY(Print): t fcV ,ui r�dlSo� (sign) <br /> 1. Describe type of packing in cooler: 1n Z' D c NO <br /> 2. Did all bottles arrive unbroken?....................................................................... <br /> 3. Were labels in good condition and complete (ID, date, time, signature, etc.)?..• NO <br /> NO <br /> 4. Did bottle labels agree with custody papers?.................................................... <br /> 5. Were appropriate containers used for the tests indicated?................................. � NO <br /> 6. Were correct preservatives added to samples?.................................................. NO <br /> ' 7 . Was sufficient amount of sample sent for tests indicated?.................................(ID NO i <br /> g. Were bubbles absent in VOA samples?If NO, list sample Ids below.................YES NO <br /> 9. Was the client contacted concerning this sample delivery?................................ YES NO <br /> If YES, give details below. <br /> Who was called? By whom? Date: <br /> Additional Comments: <br /> Rev.7,4195 , <br /> Filename:F:�qc\forrnslgc�cooler.dac . <br />
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