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4200 – Liquid Waste Program
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PR0546963
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COMPLIANCE INFO
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Last modified
12/21/2022 9:53:08 AM
Creation date
12/20/2022 4:00:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200 – Liquid Waste Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0546963
PE
4233
FACILITY_ID
FA0026607
FACILITY_NAME
KEVIN WENTWORTH
STREET_NUMBER
462
Direction
W
STREET_NAME
JOSEPH
STREET_TYPE
RD
City
MANTECA
Zip
95336
CURRENT_STATUS
01
SITE_LOCATION
462 W JOSEPH RD
P_LOCATION
04
QC Status
Approved
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FGL Environmental Doc ID:3DO900002_SOP_12.DOC <br /> Revision Date: 10/09/14 Page 1 of 1 <br /> Inte _ ory Condition Upon Receipt (Attach to COC) v�v��1-1121� <br /> Sample Receipt STK CC CH VI <br /> 1. Number of is ackages received: Shipping tracking# <br /> 2. Were samples received in a chilled condition? Temps: 134,1, <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? Y No N/A <br /> 4. Were samples received intact?(i.e. no broken bottles, leaks etc o <br /> 5. VOAs checked for Headspace? Yes N <br /> 6. Were sample custody seals intact? Yes N <br /> 7. If required, was sample split for pH analysis? N <br /> 8. Were all analyses within holding times at time of receipt? No <br /> 9. Verify sample date,time and sampler name es No <br /> Sign and date the COC,place in a ziplock and put in s e ice ch samples. <br /> Sample Receipt Review completed by (initials): <br /> Sample Receipt at SP: <br /> 1. Were samples received in a chilled condition? Temps: a/ <br /> p p � ! <br /> Acceptable is above freezing to 60 C. If many packages are received at one time check for tests/H.T.'s/rushes/ <br /> 2. Shi ping tracking numbers: <br /> Vf 4�71 M(p, �w[1 4I, f l qu, 16z 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.) No <br /> 5. Were sample custody seals intact? Yes No 1�5 <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? Oes <br /> No <br /> 3. Were all bottles requiring sample preservation properly preserved? No FGL <br /> lException: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 / <br /> 6. Were all analyses within holding times at time of receipt? es No <br /> Attach labels to the containers and include a copy of the COC for lab elive . <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: <br /> Resolution: - - - <br /> (3017919) <br /> 2. Person Contacted: San Joaquin County END <br /> Initiated By: <br /> Problem: STIQ257370 <br /> Resolution: iv 12/08/2022 07:17:48 <br /> Ili 1111111111111111f11111111111111�(il <br /> (Please use the back of this sheet for additional coi,uuL.,..,. <br /> contacts) <br />
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