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v <br />CLIENT: _SweTA Pwa�`ET�CA� <br />Page 9 of 9 <br />WORK ORDER #: O9-12- RO®® U <br />Cooler t of t <br />DATE: 12100109 <br />TEMPERATURE: (Criteria:0.0eC-6.0*C,not frozen) <br />Temperature 3 . '1 eC - 0.8 eC (CF) = 3 - \ 0 ❑ Blank <br />IQ 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 />/�, <br />U-0 <br />Ambient Temperature: ❑ Air ❑ Filter ❑ Metals Only ❑ PCBs Only <br />Initial: <br />CUSTODY SEALS INTACT: <br />t <br />❑Cooler ❑ ❑ No (Not Intact) Present E: N/A <br />initial: <br />O Nom�ot <br />❑ Sample El EI (Not Intact) t Present <br />Initial: <br />SAMPLE CONDITION: Yes <br />No NIA <br />Chain -Of -Custody (COC) documents) received with samples ................... H <br />❑ ❑ <br />COC document(s) received complete..................................................:-04�- <br />'Z ❑ <br />-ffCollec on dateltime, matrix, and/or # of containers logged in based on sample label*. <br />❑ No analysis requested. ❑ Not relinquished. ❑ No date/time relinquished. <br />............... <br />Sampler's name indicated on COC............I ............... i ........ <br />1:1 11 <br />i / <br />Sarrip)e container label(s) consistent with COC ............. t....................... IZf <br />❑ ❑ <br />Sample containers) intact and good condition ...................................... / <br />❑ ❑ <br />Correct containers and volume for analyses requested ........................... <br />❑ ❑ <br />Analyses received within holding time ................................................. <br />❑ ❑ <br />Proper preservation noted on COC or sample container .......................... ❑ <br />❑ 0� <br />❑ Unpreserved vials received for Volatiles analysis <br />Volatile analysis container(s) free of headspace..................................... ❑ <br />❑ ¢moi <br />Tedlar bag(s) free of condensation...................................................... ❑ <br />❑ <br />CONTAINER TYPE: <br />Solid: 40zCGJ ❑BozCGJ 016ozCGJ ❑Sleeve ❑EnCorese ❑TerraCoreso <br />❑ <br />Water: ❑VOA ❑VOAh ❑VOAna2 0125AGB 0125AGBh 11125AGBp ❑1AGB <br />01AGBna2 01AGBs <br />❑500AGB ❑500AGJ 1--1500AGJs 0250AGB ❑250CGB 0250CGBs 01PB <br />0500PB 0500PBna <br />0250PB 13250PBn ❑125PB 0125PBznna 0100PJ 0100PJna2 ❑ ❑ <br />❑ <br />Air: ❑Tediaro ❑Summa® Other: ❑ Trip Blank Lot#: <br />Checked by:,_�f� <br />Container. C: Clear A: Amber P: Plastic e: Glass J: Jar B: Botta Z: Ziploc/Ressalable Bap E: Envelop <br />Reviewed by: W,5( <br />Prasanraew: h: HCL n: HNO3 rer:NarSrO. No: NaOH p: HrPo, s: Ha.SO, arms: ZnAc:+NaOH r: Fleld•atared <br />Scanned by: _ <br />sar nue uvu Prnaort <br />