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CLIENT: CCtrdtia ER n <br />Page 33 of 33 <br />WORK ORDER #: 12-0500191 D D <br />Cooler t of <br />DATE: 05 / 6 112 <br />TEMPERATURE: Thermometer ID: SC2 (Criteria: 0.0°C — 6.0°C, not frozen) <br />Temperature cXc. 4 OC-0.30C(CF) = OL . I °C 9Blank ❑ 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. <br />Ambient Temperature: ❑ Air ❑ Filter Initial: <br />CUSTODY SEALS INTACT: <br />Wcooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: <br />❑ Sample ❑ ❑ No (Not Intact) ErIlot Present Initial: 5 <br />SAMPLE CONDITION: <br />Yes <br />No <br />N/A <br />Chain -Of -Custody (COC) document(s) received with samples ................. <br />. . IT"' <br />❑ <br />❑ <br />COC document(s) received complete ....................... -- ................... <br />..... 0"-, <br />❑ <br />❑ <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 />3-' <br />❑ <br />❑ <br />Sample container label(s) consistent with COC ...................................... <br />ff -, <br />CJ <br />❑ <br />Sample container(s) intact and good condition ....................................... <br />13 <br />❑ <br />❑ <br />Proper containers and sufficient volume for analyses requested ................ <br />l <br />❑ <br />❑ <br />Analyses received within holding time .................................................. <br />Grl� <br />❑ <br />❑ <br />pH / Res. Chlorine / Diss. Sulfide / Diss. Oxygen received within 24 hours.., ❑ <br />❑ <br />Cl! <br />Proper preservation noted on COC or sample container .......................... 12< <br />❑ <br />❑ <br />❑ Unpreserved vials received for Volatiles analysis <br />Volatile analysis container(s) free of headspace..................................... <br />C <br />❑ <br />❑ <br />Tedlar bag(s) free of condensation...................................................... <br />❑ <br />❑ <br />CONTAINER TYPE: <br />Solid: 04ozCGJ ❑8ozCGJ ❑16ozCGJ ❑Sleeve ❑EnCorese ❑TerraCorese ❑ <br />Water: ❑VOA 14OAh ❑VOAna2 ❑125AGB ❑125AGBh ❑125AGBp 01AGB 01AGBna2 01AGBs <br />0500AGB ET500AGJ ❑500AGJs 0250AGB ❑250CGB 0250CGBs 01PB 01PBna 0500PB <br />1:1250PB ©250PBn 0125PB 0125PBznna 0100PJ 0100PJna2 ❑ ❑ ❑ <br />Air: ❑Tedlae ❑Summa® Other: U Trip Blank Lot#: Labeled/Checked by: r5 <br />Container: C: Clear A: Amber P: Plastic G: Glass J: Jar B: Bottle Z: Ziploc/Resealable Bag E: Envelope Reviewed by: YOc- <br />Preservative: h: HCL n: HNO3 na2:Na2S203 na: NaOH p: HaPO4 s: H2SO4 u: Ultra -pure znna: ZnAc2+NaOH f: Filtered Scanned by!A5 C_ <br />SOP T100 090(12106111) <br />