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Page 35 of 36 <br /> nVIM�„ a„ l WORK ORDER M 12-03-© 0 0 <br /> L.Mbo 9Btodeo, Inc. <br /> Cooler of <br /> CLIENT: R� DATE: 03 7/12_ <br /> TEMPERATURE: Thermometer ID: SC3 (Criteria: 0.0°C—6.0°C, not frozen) <br /> Temperature 0 OC - 0.3 OC (CF) _ •�OC DBlank ❑ Sample <br /> ❑ Sample(s)outside temperature criteria(PM/APM contacted by: ). <br /> ❑ Sample(s)outside temperature criteria but received on ice/chilled on same day of sampling. <br /> ❑ Received at ambient temperature, placed on ice for transport by Courier. v <br /> Ambient Temperature: ❑ Air ❑ Filter Initial. 1 <br /> CUSTODY SEALS INTACT: C.. <br /> OCooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: <br /> ❑ Sample ❑ ❑ No (Not Intact) Not Present Initial: PT <br /> Fr <br /> AMPLE CONDITION: Yes No NIA <br /> hain-Of-Custody (COC)document(s) received with samples................... [ ❑ 11OC document(s) received complete................................................... ❑ ❑ <br /> ❑Collection date/time,matrix,and/or#of containers logged in based on sample labels. <br /> ❑ No analysis requested. ❑ Not relinquished. ❑No date/time relinquished. <br /> Sampler's name indicated on COC...................................................... ❑ ❑ <br /> Sample container label(s) consistent with COC...................................... ❑ ❑ <br /> Sample container(s) intact and good condition.......................................pill' ❑ ❑ <br /> Proper containers and sufficient volume for analyses requested................ 2r ❑ ❑ <br /> Analyses received within holding time..................................................X ❑ ❑ <br /> pH / Res. Chlorine/ Diss. Sulfide/ Diss. Oxygen received within 24 hours... ❑ ❑ 21" <br /> Proper preservation noted on COC or sample container.......................... ❑ ❑ <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s)free of headspace..................................... ❑ ❑ <br /> Tedlar bag(s)free of condensation............................................I......... ❑ ❑ <br /> CONTAINER TYPE: <br /> Solid: 04ozCGJ 08ozCGJ 016ozCGJ ❑Sleeve ❑EnCoreso ❑TerraCores® ❑f <br /> Water: ❑VOA ,IVOM ❑VOAna2 ❑125AGB 0125AGBh 0125AGBp ❑1AG6 01AGBna2 01AGBs <br /> 0500AGB 6500AGJz 0500AGJs 0250AGB 0250CGB 0250CGBs 01PB 01PBna 0500PB <br /> 0250PB Z/250PBnu0125PB 0125PBznna 0100PJ 0100PJna2 ❑ ❑ ❑ <br /> Air: ❑Tedlar® ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by: <br /> Container: C:Clear A:Amber P:Plastic G:Glass J:Jar B:Bottle Z:ZiplodResealable Bag E:Envelope Reviewed by:. <br /> Preservative: h:HCL n:HNO3 na2:N82S203 no:NaOH p:H3PO4 a:H2SO4 u:Ultra-pure znna:ZnAc2+NaOH f:Filtered Scanned by <br /> SOP T700 090(12106(11) <br />