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WP0041523
EnvironmentalHealth
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4300 - Water Well Program
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WP0041523
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Last modified
6/7/2021 1:38:18 PM
Creation date
6/7/2021 1:37:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4300 - Water Well Program
RECORD_ID
WP0041523
PE
4366
STREET_NUMBER
17101
Direction
E
STREET_NAME
BRANDT
STREET_TYPE
RD
City
LODI
Zip
95240-
APN
01914003
ENTERED_DATE
12/10/2020 12:00:00 AM
SITE_LOCATION
17101 E BRANDT RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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Tags
EHD - Public
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FGL Environmental Doc ID: 3DO900002_SOP_12-1.DOC , <br />Revision Date: 10/09/14 Page 1 of 1 <br />Inter-Ltory Condition Upon Receipt (Attach to COC) <br />Sample Receipt at: STK CC CH VI <br />1. Number of ice ches s/packages received: Shipping tracking # <br />2. Were samples received in a chilled condition? Temps: Jam• / / / / <br />Surface water SWTR bact samples: A sample that has a temperature upon receipt of >10' C, whether iced or not, <br />should be flagged unless the time since sample collection has been less than two hours. <br />3. Do the number of bottles received agree with the COC? es No N/A <br />4. Were samples received intact? (i.e. no broken bottles, leaks etc.) Yes No <br />5. VOAs checked for Headspace? Yes No CM <br />6. Were sample custody seals intact? Yes No <br />7. If required, was sample split for pH analysis? --- _ No <br />8. Were all analyses within holding times at time of receipt? No <br />9. Verify sample date, time and sampler e Yes No <br />Sign and date the COC, place in a ziplock and put ' e ame ice chest as the samples. <br />Sample Receipt Review completed by (initials): <br />Sample Receipt at SP: <br />1. Were samples received in a chilled condition? Temps: <br />Acceptable is above freezing to 60 C. if many packages are received at one t' a check for tests/H.T.'s/rushes/ <br />2. Shipping tracking numbers: // q3� // <br />3. Do the number of bottles received agree with the COC? No N/A <br />4. Were samples received intact? (i.e. no broken bottles, leaks etc.) Yes No <br />5. Were sample custody seals intact? Yes No <Z:N� <br />Sign and date the COC, obtain LIMS sample numbers, select methods/tests and print labels. <br />Sample Verification, Labeling and Distribution: <br />1. Were all requested analyses understood and acceptable? es No <br />2. Did bottle labels correspond with the client's ID's? No <br />3. Were all bottles requiring sample preservation properly preserve Yes No N/A FGL <br />[Exception: Oil & Grease, VOA and CM verified in lab] <br />4. VOAs checked for Headspace? Yes No <br />5. Have rush or project due dates been checked and accepted? Yes No N <br />6. Were all analyses within holding times at time of receipt? e No <br />Attach labels to the containers and include a copy of the COC 1 v <br />Sample Receipt, Login and Verification completed by (initials <br />Discrepancy Documentation: <br />Any items above which are "No" or do not meet specifications (i.e. temps) must be resolved. <br />1. Person Contacted: Phone Number: <br />Initiated By: Date: <br />Problem: <br />Resolution: <br />2. Person Contacted: Pl,n, l�Tnmh�r• <br />Initiated By: (3017919) <br />Problem: San Joaquin County EHE <br />Resolution: STK2135169 (Please use the back of this sheet for additional cc <br />contacts) apb 04/15/2021 16:35:40 <br />IIII <br />T111IIIIIIII <br />
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