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0 Login Sample Receipt Checklist 0 <br />Client: Univar USA, Inc. Job Number: 720-34202-2 <br />Login Number: 34202 <br />List Source: TestAmerica San Francisco <br />List Number: 1 <br />Creator: Thomas, Bryan <br />Question <br />Answer Corturwat <br />Radioactivity either was not measured or, if measured, is at or below <br />N/A <br />background <br />The cooler's custody seal, if present, is intact. <br />N/A <br />The cooler or samples do not appear to have been compromleed or <br />True - <br />tampered with. <br />Samples were received on ice. <br />True <br />Cooler Temperature is acceptable. <br />True <br />Cooler Temperature is recorded. <br />True <br />COC is present. <br />True <br />COC is filled out in ink and legible. <br />True <br />COC is filled out with all pertinent information. <br />True <br />Is the Field Sampler's name present on COC? <br />True <br />There are no discrepancies between the sample IDs on the containers and <br />True <br />the COC. <br />Samples are received within Holding Time. <br />True <br />Sample containers have legible labels. <br />True <br />Containers are not broken or leaking. <br />True <br />Sample collection date/times are provided. <br />True <br />Appropriate sample containers are used. <br />True <br />Sample bottles are completely filled. <br />True <br />Sample Preservation Verified <br />N/A <br />There is sufficient vol. for all requested analyses, incl. any requested <br />True <br />MS/MSDs <br />VOA sample vials do not have headspace or bubble is <6mm (1/4") in <br />True <br />diameter. <br />If necessary, staff have been informed of any short hold time or quick TAT <br />True <br />needs <br />Multiphasic samples are not present. <br />True <br />Samples do not require splitting or compositing. <br />True <br />TestAmerica San Francisco <br />Page 13 <br />of 13 04/13/2011 <br />