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RECEIVED Page 10 of 10 - FEB 16 2016 ENVIRONMENTALWORK ORDER #: 12-07-El [71 D .� E Cooler / of CLIENT: 1< DATE: 07/3 1112 TEMPERATURE:: Thermometer ID: SC2 (Criteria: 0.0°C —6.0°C, not froze,.n_)� Temperature I - T OC - 0.30C (CF) = 1 •�°C Lt Blank ❑ Sample ❑ Sample(s) outside temperature criteria (PM/APM contacted by: ). ❑ Sample(s)outside temperature criteria but received on ice/chilled on same day of sampling. O Received at ambient temperature, placed on ice for transport by Courier. Ambient Temperature: ❑ Air ❑ Filter Initial: r CUSTODY SEALS INTACT:❑ Cooler ❑ ❑ No (Not Intact) ��c Present ❑ N/A Initial: EISample El ❑ No (Not Intact) Not Present Initial: SAMPLE CONDITION: Yes No N/A CI',rain-Of-Custody (COC) document(s) received with samples................... ❑ ❑ COC document(s) received complete....................................................R� ❑ ❑ ❑ Collection date/time, matrix,and/or#of containers logged in based on sample labels. ❑ No analysis requested. ❑ Not relinquished. ❑No date/time relinquished. / Sampler's name indicated on COC...................................................... ❑ ❑ �J Sample container label(s) consistent with COC.......................................JA ❑ ❑ Sample container(s) intact and good condition....................................... to/ ❑ ❑ Proper containers and sufficient volume for analyses requested................ Q] ❑ ❑ Analyses received within holding time.................................................. 1� ❑ ❑ pH / Res. Chlorine/ Diss. Sulfide/ Diss. Oxygen received within 24 hours... ❑ ❑ ;?,- Proper preservation noted on COC or sample container.......................... ❑ ❑ IF,," ❑ Unpreserved vials received for Volatiles analysis Volatile analysis container(s)free of headspace..................................... O ❑ Tedlar bag(s) free of condensation...................................................... ❑ ❑ (� CONTAINER TYPE: Solid: 04ozCGJ ❑8ozCGJ ❑16ozCGJleeve (--S ) OEnCoreso OTerraCores® ❑ Water: ❑VOA OVOAh ❑VOAna2 ❑125AGB ❑125AGBh 0125AGBp ❑1AGB 01AGBna2 01AGBs 0500AGB 0500AGJ 13500AGJs 0250AGB 11250CGB 0250CGBs ❑1PB ❑1PBna ❑500PB 0250PB 0250PBn 0125PB ❑125PBznna 0100PJ ❑100PJna2 ❑ ❑ O Air: ❑Tedlar® ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by: Container: C:Clear A:Amber P:Plastic G: Glass J:Jar B:Bottle Z:Ziploc/Resealabie Bag E:Envelope Reviewed by: L-- Preservative: h:HCL n:HNO3 na2:Na2S203 na:NaOH p:H3PO4 s:H2SO4 u:Ultra-pureznna:ZnAc2+NaOH f:Filtered Scanned by:ja�,— SOP 77 00_090(12106111)