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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# Date Received �A' 1 Number of coolers <br /> Client 14.98ZPrghect k3ttNu. Fifi _ <br /> Date Opened By(print) Wk. <br /> Date Logged in 1, _ By(print) (sign) <br /> 1. Did cooler come with a shipping slip(airbill, etc) <br /> Shipping info <br /> 2A. Were custody seals present? .... YES (circle) on cool on samples ElNO <br /> How many Name z 1a�i'Iti�e Date Lf-H Ir <br /> 2B. Were custody seals intact upon arrival? —J NO N/A <br /> 3. Were custody papers dry and intact when received? NQ <br /> 4. Were custody papers filled out properly(ink, signed, etc)? YES <br /> 5. Is the project identifiable from custody papers?(If so fill out top of form)_ NO <br /> 6. Indicate the packing in cooler: (if other, describe) <br /> `(.Bubble Wrap ❑Foam blocks ;Bags ❑None <br /> b Cloth material ❑Cardboard ❑Styrofoam ❑Paper towels <br /> 7. Temperature documentation: <br /> Type of ice used: ` ,Wet ❑Blue/Gel ❑None Temp(°C) <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 QJW <br /> If YES,what time were they transferred to freezer? <br /> 9. Did all bottles arrive unbroken/unopened? 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 YES NO N/A <br /> 17. Are bubbles>6mm absent in VOA samples? YES® N/A <br /> 18. Was the client contacted concerning this sample delivery? YES dqM <br /> If YES,Who was called? By Date: <br /> COMMENTS <br /> _ Q as <br /> �lA MnAUIWA <br /> o (P <br /> SOP Volume: Client Services Rev.7 Number 1 of 1 <br /> Section: 1.1.2 Effective: I September 2010 <br /> Page: 1 of 1 F:\gc\sop\client services\Cooter Receipt Checklist rv7.doc <br /> 6of6 <br />
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