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' • 0 Page 21 of 24 <br /> y. Caen WORK ORDER #: ® ® E] 17il Q <br /> nxdronraaaxxt�f <br /> alaarstvries,. k1e. ' Cooler of-4 <br /> CLIENT: V,� ( r/ <br /> DATE: —LZ IO� I OFA' <br /> TEMPERATURE: (Criteria: 0.0°C-6.0°C, not frozen) <br /> Temperature --d. L _°C - 0.2°C (CF) = L- •-�—°C (Blank ❑ Sample <br /> ❑ Sample(s)outside temperature criteria (PM/APM contacted by: ). <br /> ❑ Sample(s)outside temperature criteria but received on icelchilled on same day of sampling. <br /> ❑ Received at ambient temperature, placed on ice for transport by Courier. <br /> Ambient Temperature: ❑ Air ❑ Filter ❑ Metals Only ❑ PCBs Only Initial: ( <br /> ` C/USTODY SEALS INTACT: <br /> C Cooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: n'L <br /> ' ❑ Sample ❑ ❑ No (Not Intact) IdNot Present Initial: rlv <br /> ' SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody (COC) document(s) received with samples... .. C°1 ❑ ❑ <br /> ' COC document(s) received complete........................................ ❑ Q ❑ <br /> Sampler's name indicated on COC........................................... ❑ ❑ d <br /> Sample container label(s)consistent with COC........................... ld ❑ ❑ <br /> ' Sample container(s) intact and good condition............................ CI ❑ ❑ <br /> Correct containers and volume for analyses requested................. 10 ❑ ❑ <br /> Analyses received within holding time...................................... 9 71 El <br /> J <br /> Proper preservation noted on sample label(s)............................. 0 ❑ ❑ <br /> Volatile analysis container(s)free of headspace.......................... ❑ ❑ Z <br /> Tedlar bag(s)free of condensation.......................................... ❑ ❑ d <br /> CONTAINER TYPE: <br /> Solid: [54ozCGJ ❑8ozCGJ 016ozCGJ ❑Sleeve ❑EnCOres@ ❑TerraCores® ❑ <br /> ' Water: ❑VOA ❑VOAh 0VOAna2 ❑125AGB 0125AGBh 11125AGBpo4 111AGB 1d1AGBna2 <br /> ❑1AGBs 11500AGB 0500AGBs 0250CGB 1:1250CGBs Eid1PB ❑500PB ❑500PBna ❑250PB <br /> 0250PBn ❑125PB 11125PBznna 11100PBsterile 0100PBna2 ❑ ❑ ❑ <br /> Air: ❑Tedlar® ❑Summa® ❑ Checked/Labeled by: <br /> , <br /> Container: C:Clear A:Amber P:PoiylPlasEc GGlass J:Jar B:Bottle Reviewed by: IAh <br /> Preservative: h:HCL n:HNO, nar:Na2S203 na:NaOH po.:H,PO, s:HzSO, znna:ZnAcz+NaOH Scanned by: <br /> SOP T700 090(11/20108) <br />