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C <br /> Login Sample Receipt Checklist <br /> Client:Bureau Veritas North America, Inc. Job Number:720-49923-1 <br /> Login Number:49923 List Source:TestAmerica Chicago <br /> List Number: 1 List Creation:06/04/13 11:34 AM <br /> Creator:Lunt,Jeff T <br /> Question Answer Comment <br /> Radioactivity wasn't checked or is</=background as measured by a survey True <br /> meter. <br /> The cooler's custody seal, if present,is intact. True <br /> Sample custody seals,if present,are intact. True <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. True <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. True m <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. True <br /> There is sufficient vol.for all requested analyses,incl.any requested True <br /> MS/MSDs <br /> Containers requiring zero headspace have no headspace or bubble is True <br /> <6mm(1/4"). <br /> Multiphasic samples are not present. True <br /> Samples do not require splitting or compositing. True <br /> Residual Chlorine Checked. True <br /> TestAmerica Pleasanton <br /> Page 67 of 67 6/5/2013 <br />