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Client: United Pumping Service <br />Login Number: 54166 <br />List Number: 1 <br />Creator: Mullen, Joan <br />Question <br />Radioactivity wasn't checked or is </= ba <br />meter. <br />The coolers custody seal, if present, is ii <br />Sample custody seals, if present, are int; <br />The cooler or samples do not appear to I <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 inform <br />Is the Field Sampler's name present on ( <br />There are no discrepancies between the <br />Samples are received within Holding Tirr <br />Sample containers have legible labels. <br />Containers are not broken or leaking. <br />Sample collection date/times are provide <br />Appropriate sample containers are used. <br />Sample bottles are completely filled. <br />Sample Preservation Verified. <br />There is sufficient vol. for all requested a <br />MS/MSDs <br />Containers requiring zero headspace ha, <br /><6mm (1/4'). <br />Multiphasic samples are not present. <br />Samples do not require splitting or comp <br />Residual Chlorine Checked. <br />TestAmerica Pleasanton <br />Login Sample Receipt Checklist <br />round as measured by a survey <br />been compromised or <br />received and the COC. <br />;s, incl. any requested <br />headspace or bubble is <br />Answer Comment <br />N/A <br />N/A <br />N/A <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: 72054166-1 <br />List Source: TestAmerica Pleasanton <br />12/12/2013 <br />UP_006058 <br />