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Login Sample Receipt Checklist <br />' Client: Republic Services Inc <br />Login Number: 5296 <br />' List Number: 1 <br />Creator: Wienke, Robert <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, is intact. <br />The cooler or samples do not appear to 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 information. <br />Is the Field Sampler's name present on COC? <br />There are no discrepancies between the sample IDs on the containers and <br />' the COC. <br />Samples are received within Holding Time. <br />Sample containers have legible labels. <br />Containers are not broken or leaking. <br />Sample collection date/times are provided. <br />Appropriate sample containers are used. <br />' Sample bottles are completely filled. <br />Sample Preservation Verified <br />There is sufficient vol. for all requested analyses, incl. any requested <br />MS/MSDs <br />VOA sample vials do not have headspace or bubble is <6mm (1/4") in <br />diameter. <br />If necessary, staff have been informed of any short hold time or quick TAT <br />' needs <br />Multiphasic samples are not present. <br />Samples do not require splitting or compositing. <br />1 Sampling Company provided. <br />Samples received within 48 hours of sampling. <br />Samples requiring field filtration have been filtered in the field. <br />' Chlorine Residual checked. <br />' TestAmerica Buffalo <br />Job Number: 480-5296-1 <br />List Source: TestAmerica Buffalo <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 />True <br />True <br />True <br />True <br />True <br />True HERST AND ASSOCIATES <br />True <br />N/A <br />N/A <br />Page 21 of 21 <br />05/31/2011 <br />