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WP0043666
Environmental Health - Public
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FOREST LAKE
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4300 - Water Well Program
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WP0043666
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Last modified
11/15/2022 2:34:24 PM
Creation date
11/15/2022 2:16:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4300 - Water Well Program
RECORD_ID
WP0043666
PE
4370
STREET_NUMBER
3522
Direction
E
STREET_NAME
FOREST LAKE
STREET_TYPE
RD
City
ACAMPO
Zip
95220-
APN
00514123
ENTERED_DATE
8/23/2022 12:00:00 AM
SITE_LOCATION
3522 E FOREST LAKE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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FGL Environmental Doc ID: 3D0900002_SOP_12.DOC <br /> Revision Date: 10/09/14 Page 1 of 1 <br /> Inter-La atory Condition Upon Receipt (Attach to COC) <br /> Sample Receipt at: STK CC CH VI <br /> 1. Number of ice chests/packages received: Shipping tracking# <br /> 2. Were samples received in a chilled condition? Temps: - / / <br /> Surface water SWTR bact samples:A sample that has a temperature upon receipt of >10'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.) 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 nameYes No <br /> Sign and date the COC,place in a ziplock and put in e e 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: <br /> Acceptable is above freezing to 6U Cif many p ages are receivat one time check for tests/H.T.'s/rushes/ <br /> 2. Shipping tracking numbers:`5�j5 1 16 Q�� ( <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.) qMe No <br /> 5. Were sample custody seals intact? Yes No T� <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? No <br /> 2. Did bottle labels correspond with the client's ID's? No <br /> 3. Were all bottles requiring sample preservation properly preserved? z:f�i5> No N/A FGL <br /> [Exception:Oil&Grease,VOA and CM verified in labl <br /> 4. VOAs checked for Headspace? Yes No <br /> 5. Have rush or project due dates been checked and accepted? Yes No 4!!5 <br /> 6. Were all analyses within holding times at time of receipt? s No <br /> Attach labels to the containers and include a copy of the COC fb deli <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: Date: _ <br /> Problem: (3017919) <br /> Resolution: EHD <br /> San Joaquin County <br /> 2. Person Contacted: <br /> Initiated By: STU255140 <br /> Problem: cda 1012112022 09:58:05 <br /> Resolution: �11111111110111111111111111111 <br /> STK2255140 <br /> a <br /> (Please use the back of this sheet for additional c ✓ <br /> contacts) <br />
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