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Login Sample Receipt Checklist <br />Client: ARCADIS U.S. Inc <br />Login Number: 69888 <br />List Number: 2 <br />Creator: Garcia, Veronica G <br />Question <br />Radioactivity wasn't checked or is </ background as measured by a <br />survey meter. <br />The cooler's custody seal, if present, s <br />Sample custody seals, if present, are ii <br />The cooler or samples do not appear s <br />tampered with. <br />Samples were received on ice. <br />Cooler Temperature is acceptable. <br />Cooler Temperature is recorded. <br />COC is present. <br />COC is filled out in ink and legible. <br />COC is filled out with all pertinent info <br />Is the Field Samplers name present <br />There are no discrepancies between t <br />Samples are received within Holding <br />HTs) <br />Sample containers have legible labels <br />Containers are not broken or leaking. <br />Sample collection date/times are provi <br />Appropriate sample containers are us <br />Sample bottles are completely filled. <br />Sample Preservation Verified. <br />There is sufficient vol. for all requeste <br />MS/MSDs <br />Containers requiring zero headspace h <br /><6mm (1/4"). <br />Multiphasic samples are not present. <br />Samples do not require splitting or con <br />Residual Chlorine Checked. <br />TestAmerica Pleasanton <br />intact. <br />have been compromised or <br />COC? <br />e containers received and the COC. <br />me (excluding tests with immediate <br />analyses, incl. any requested <br />no headspace or bubble is <br />Answer Comment <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />True <br />N/A <br />True <br />True <br />True <br />True <br />N/A <br />Page 27 of 27 <br />Job Number: 720-69888-1 <br />List Source: TestAmerica Irvine <br />List Creation: 01/23/16 02:49 PM <br />1/28/2016 <br />15' <br />UP_005982 <br />