Laserfiche WebLink
Page6of6 <br /> Ar* WORK ORDER #: 09-03' LJ ® 0 <br /> Aj= <br /> hm. ' ' :1 3= Cooler \ of k <br /> CLIENT: Y,� DATE: ` ) k a I Oq <br /> TEMPERATURE: (Criteria: 0.0°C-6.0°C, not frozen) � <br /> Temperature 2 . 5 °C - 0.2eC (CF) = 2- -�°C 0 Blank ❑ 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 ❑ Metals Only ❑ PCBs Only Initial: <br /> CUSTODY SEALS INTACT: <br /> O'Cooler ❑ ❑ No(Not Intact) ❑ Not Present ❑ N/A Initial: <br /> ❑ Sample ❑ ❑ No (Not Intact) 'Not Present Initial: <br /> SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody(COC)document(s)received with samples................... 11 <br /> COC document(s)received complete................................................... 0 ❑ ❑ <br /> ❑ Collection date/time,matrix,and/or#of containers logged in based on sample labels. <br /> ❑ COC not relinquished. ❑No date relinquished. ❑No 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...................................... 13 13C3// <br /> Correct containers and volume for analyses requested........................... ['1/ ❑ ❑ <br /> Analyses received within holding time................................................. Q ❑ ❑ <br /> Proper preservation noted on COC or sample container.......................... ❑ ❑ <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s)free of headspace..................................... Cl ❑ <br /> Tedlar bag(s)free of condensation...................................................... ❑ ❑ <br /> CONTAINER TYPE: <br /> Solid: 04ozCGJ 08ozCGJ 016ozCGJ ❑Sleeve ❑EnCores® ❑TerraCorese ❑ <br /> Water: ❑VOA ❑VOAh ❑VOAna2 0125AGB ❑125AGBh 5AGBpo, 01AGB 01AGBna2 <br /> ❑1AGBs 0500AGB 0500AGBs 0250CGB ❑250CGBs PS ❑500PB 11500PBna ❑250PB <br /> 0250PBn 0125PB 0125PBznna 0100PBsterile 0100PBna2 ❑ ❑ El <br /> Air: ❑Tedlar® ❑Summa® ❑ Sludge/Other: ❑ Checked/Labeled by., <br /> Container. C:Clmr A•.Amber P:Poly/Plwtc G:Glass J:Jar B:Botde Reviewed by: <br /> Preservative: h:HCL n:HNOa n%:Naz%O, na:NaOH po.:H3PO. s:HiSO. znns2nAcs-NaOH Scanned by: <br /> SOP T100_090(03/13/09) <br /> r <br />