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Login Sample Receipt Checklist <br />Client: United Pumping Service <br />Login Number: 2207 <br />List Number: 1 <br />Creator: Robb, Kathleen <br />Question <br />Radioactivity either was not measured or, if measured, is at or below <br />background <br />The cooler's custody seal, if present, i intact. <br />The cooler or samples do not appear t have been compromised or <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 inforr iation. <br />Is the Field Sampler's name present on COC? <br />There are no discrepancies between th sample IDs on the containers and <br />the COC. <br />Samples are received within Holding Ti e. <br />Sample containers have legible labels. <br />Containers are not broken or leaking. <br />Sample collection date/times are provid <br />Appropriate sample containers are use . <br />Sample bottles are completely filled. <br />Sample Preservation Verified. <br />There is sufficient vol. for all requested nalyses, incl. any requested <br />MS/MSDs <br />VOA sample vials do not have headspar�e or bubble is <6mm (1/4") in <br />diameter. <br />Multiphasic samples are not present. <br />Samples do not require splitting or comdositing. <br />Residual Chlorine Checked. <br />Answer Comment <br />True <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 />Job Number: 440-2207-2 <br />List Source: TestAmerica Irvine <br />RECEIVE[',.: <br />FEB 18 2014 <br />ENVIRONMENTAL <br />HEALTH DEPAMMENT <br />TestAmerica Irvine <br />Page 20 of 20 11/26/2013 <br />