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Login Sample Receipt Checklist <br /> Client: Dysert Environmental, Inc Job Number: 720-86460-1 <br /> Login Number: 86460 List Source: TestAmerica Pleasanton <br /> List Number: 1 <br /> Creator: Bullock,Tracy <br /> Question Answer Comment <br /> Radioactivity wasn't checked or is<1=background as measured by a survey NIA <br /> meter. <br /> The cooler's custody seal, if present, is intact. NIA <br /> Sample custody seals, if present, are intact. NIA <br /> The cooler or samples do not appear to have been compromised or True <br /> tampered with. <br /> Samples were received on ice. True <br /> Cooler Temperature is acceptable. True <br /> Cooler Temperature is recorded. True <br /> COC is present. True <br /> COC is filled out in ink and legible. True <br /> COC is filled out with all pertinent information. False <br /> Is the Field Sampler's name present on COC? True <br /> There are no discrepancies between the containers received and the COC. True <br /> Samples are received within Holding Time(excluding tests with immediate True <br /> HTs) <br /> Sample containers have legible labels. True <br /> Containers are not broken or leaking. True <br /> Sample collection date/times are provided. True <br /> Appropriate sample containers are used. True <br /> Sample bottles are completely filled. True <br /> Sample Preservation Verified. NIA <br /> There is sufficient vol. for all requested analyses, incl. any requested True <br /> MSIMSDs <br /> Containers requiring zero headspace have no headspace or bubble is True <br /> <6mm(114"). <br /> Multiphasic samples are not present. True <br /> Samples do not require splitting or compositing. True <br /> Residual Chlorine Checked. NIA <br /> TestAmerica Pleasanton <br /> Page 75 of 75 5/21/2018 <br />