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WP0042166
Environmental Health - Public
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4300 - Water Well Program
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WP0042166
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Entry Properties
Last modified
6/30/2022 4:28:24 PM
Creation date
6/30/2022 4:26:16 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4300 - Water Well Program
RECORD_ID
WP0042166
PE
4370
STREET_NUMBER
16940
Direction
E
STREET_NAME
DAVIS
STREET_TYPE
AVE
City
LINDEN
Zip
95236-
APN
09114009
ENTERED_DATE
6/18/2021 12:00:00 AM
SITE_LOCATION
16940 E DAVIS AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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FGL Environmental <br />Revision Date: 10/09/14 <br />Doc ID: 3DO900002_SOP_12-4.DOC <br />Page 1 of 1 <br />Inter -L r tory Condition Upon Receipt (Attach to COC) <br />Sample Receipt at: STK CC CH VI <br />1. Number of ice the packages received: Shipping tracking # <br />2. Were samples received in a chilled condition? Temps: D • - / <br />Surface water SWTR bact samples: A sample that has a temperature upon receipt of >I0° C, whether iced or not, <br />should be flagged unless the time since sample collection has been less than two hours. <br />3. Do the number of bottles received agree with the COC? No N/A <br />4. Were samples received intact? (i.e. no broken bottles, leaks etc.) Yes No <br />5. VOAs checked for Headspace? Yes No <br />6. Were sample custody seals intact? Yes No <br />7. If required, was sample split for pH analysis? Yes No <br />8. Were all analyses within holding times at time of receipt? No <br />9. Verify sample date, time and sampler nam Yes No <br />Sign and date the COC, place in a ziplock andput int ame ice chest as the samples. <br />Sample Receipt Review completed by (initials): <br />Sample Receipt at SP: <br />1. Were samples received in a chilled condition? Temps: 3/ / <br />Acceptable is above freezing to 6- C. If many packages are received at one time check for tests/H.T.'s/rushes/ <br />2. Shipping tracking numbers: <br />r)�11 C xj q5wc-o'7 3 <br />3. Do the number of bottles received agree with the COC? <br />Yes <br />No N/A <br />4. Were samples received intact? (i.e. no broken bottles, leaks etc.) <br />Yes <br />No <br />5. Were sample custody seals intact? <br />Yes <br />No N/A <br />Sign and date the COC, obtain LIMS sample numbers, select methods/tests and print labels. <br />Sample Verification, Labeling and Distribution: <br />1. Were all requested analyses understood and acceptable? <br />Yes <br />No <br />2. Did bottle labels correspond with the client's ID's? <br />Yes <br />No <br />3. Were all bottles requiring sample preservation properly preserved? <br />Yes <br />No N/A FGL <br />[Exception: Oil & Grease, VOA and CrVI verified in labl <br />4. VOAs checked for Headspace? <br />Yes <br />No N/A <br />5. Have rush or project due dates been checked and accepted? <br />Yes <br />No N/A <br />6. Were all analyses within holding times at time of receipt? <br />Yes <br />No <br />Attach labels to the containers and include a copy of the COC for lab delivery. <br />Sample Receipt, Login and Verification completed by (initials): <br />Discrepancy Documentation: <br />Any items above which are "No" or do not meet specifications (i.e. temps) must be resolved. <br />1. Person Contacted: Phone Number: <br />Initiated By: <br />Problem: <br />Resolution: <br />2. Person Contacted: <br />Initiated By: <br />Problem: <br />Resolution: <br />(Please use the back of this sheet for additior <br />contacts) <br />Date:(3017919) <br />San Joaquin County END <br />STK2233315 <br />"0oiuinimisiiii'° <br />
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