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C <br /> Login Sample Receipt Checklist <br /> Client: Safety-Kleen Systems, Inc Job Number:440-140711-1 <br /> Login Number: 140711 List Source: TestAmerica Irvine <br /> List Number: 1 <br /> Creator: Avila, Stephanie 1 <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 Thermal preservation not required. <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(excluding tests with immediate True m <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. N/A <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. N/A <br /> TestAmerica Irvine <br /> Page 22 of 22 3/15/2016 <br />