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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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2900 - Site Mitigation Program
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PR0524672
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/6/2020 10:11:48 AM
Creation date
2/6/2020 8:31:50 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0524672
PE
2965
FACILITY_ID
FA0016571
FACILITY_NAME
DEUEL VOCATIONAL INSTITUTE
STREET_NUMBER
23500
STREET_NAME
KASSON
STREET_TYPE
RD
City
TRACY
Zip
953049518
APN
23912001
CURRENT_STATUS
01
SITE_LOCATION
23500 KASSON RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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COOLER RECEIPT CHECKLIST cb Curtis&Tompkins,Ltd. <br /> ' Login# �7-Ts Date Received I Q �� NAocors IClient 1( Project OY1DateOpened ( � By(print) (sign) \ u <br /> ' Date Logged in By(print) 11.L ) <br /> 1. Did cooler come with a shipping slip(airbill,etc) YES <br /> ' Shipping info <br /> 2A. Were custody seals present? .... YES (circle on cooler on sam ;1_ ' ❑ NO <br /> How many 2. Name Date <br /> ' 2B. Were custody seals intact upon arrival? NO N/A <br /> 3. Were custody papers dry and intact when received? O <br /> 4. Were custody papers filled out properly(ink,signed, etc)? 6E9 NO <br /> 5. Is the project identifiable from custody papers?(If so fill out top of form)—AED NO <br /> 6. Indicate the packing in cooler: (if other, describe) <br /> Bubble Wrap ❑Foam blocks ,Bags ❑None <br /> ' Cloth material ❑Cardboard ❑Styrofoam ❑Paper towels <br /> 7. Temperature documentation: <br /> Type of ice used: )V Wet ❑Blue/Gel ❑None Temp(OC) 5.3 <br /> ' ❑ Samples Received on ice&cold without a temperature blank <br /> ' ❑ Samples received on ice directly from the field. Cooling process had begun <br /> 8. Were Method 5035 sampling containers present? YES <br /> If YES,what time were they transferred to freezer? <br /> 9. Did all bottles arrive unbroken/unopened? j NO <br /> 10. Are samples in the appropriate containers for indicated tests? NO <br /> 11. Are sample labels present,in good condition and complete? NO <br /> ' 12. Do the sample labels agree with custody papers? NO <br /> 13. Was sufficient amount of sample sent for tests requested? NO <br /> 14.Are the samples appropriately preserved? NO N/A <br /> ' 15. Did you check preservatives for all bottles for each sample? NO N/A <br /> 16. Did you document your preservative check NO N/A <br /> 17. Are bubbles> 6mm absent in VOA samples? NO NI <br /> ' 18. Was the client contacted concerning this sample delivery? YES <br /> If YES,Who was called? By Date: <br /> COMMENTS <br /> SOP Volume: Client Services Rev.7 Number 1 of 1 <br /> ' Section: 1.1.2 Effective: 1 September 2010 <br /> Page: 1 of 1 F:\qc\sop\client services\Cooler Receipt Cbecklist_rv7.doc <br /> 4of35 <br />
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