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1 <br /> Page 19 of 20 <br /> nn <br /> �itri,srtJ WORK ORDER #: -� -❑/ C� L7� <br /> M 'Cooler / of � <br /> ' CLIENT: G DATE: <br /> TEMPERATURE: Thermometer ID: SC1 (Criteria: 0.0°C-6.00C, not frozen) <br /> ' Temperature 2 3 OC + 0.50C (CF) _ OC P'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. YL, <br /> Ambient Temperature: ❑ Air ❑ Filter Initial: <br /> CUSTODY SEALS INTACT:FI/Cooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: / <br /> ❑ Sample ❑ ❑ No (Not Intact) 2(Not Present Initial: P( <br /> SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody (COC) document(s) received with samples................... E ❑ ❑ <br /> ' COC document(s) received complete................................................... ❑ ❑ <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..................................................... d ❑ ❑ <br /> ' Sample container label(s) consistent with COC...................................... ❑ 0' ❑ . <br /> Sample container(s) intact and good condition...................................... ❑ ❑ <br /> ' Proper containers and sufficient volume for analyses requested............... ❑ ❑ <br /> Analyses received within holding time................................................. ❑ ❑ <br /> i pH / Res. Chlorine/ Diss. Sulfide/ Diss. Oxygen received within 24 hours... ❑ 01� <br /> Proper preservation noted on COC or sample container.......................... ❑ ❑ fd <br /> ' ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s)free of headspace..................................... ❑ ❑ <br /> ' Tedlar bag(s)free of condensation...................................................... ❑ ❑ <br /> CONTAINER TYPE: <br /> Solid: ❑4ozCGJ 08ozCGJ ❑16ozCGJ Sleeve ( S ) ❑EnCores® ❑TerraCores® ❑ <br /> Water: ❑VOA ❑VOAh ❑VOAna2 0125AGB 0125AGBh 13125AGBp 01AGB ❑1AGBna2 ❑1AGBs <br /> 0500AGB 0500AGJ 0500AGJs ❑250AGB 0250CGB 11250CGBs 01PB ❑500PB ❑500PBna <br /> ' <br /> 0250PB 0250PBn 0125PB 0125PBznna 11100PJ 0100PJna2 ❑ ❑ ❑ <br /> Air: ❑Tedlar® ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by: <br /> ' Container: C:Clear A:Amber P:Plastic G:Glass J:Jar B:Bottle Z:Ziploc/Resealable Bag E:Envelope Reviewed by: we-- <br /> Preservative: h:HCL n:HNO3 na2:Na2S203 na:NaOH p:H3PO4 s:H2SO4 znna:ZnAC2+NaOH f:Field-filtered Scanned by:WE <br /> SOP T100_090(03136111) <br />