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Page 36 of 37 <br /> WORK ORDER M 11 -05- ® � <br /> ' Cooler 1 of <br /> CLIENT: -541L DATE: OJ 1&1/11 <br /> TEMPERATURE: Thermometer ID: SCI (Criteria: 0.0°C—6A°C, not frozen) /" <br /> Temperature 3. 2- °C + 0.5°C (CF) _ -� . �- n)d <br /> °C ank ❑ Sample <br /> ❑ Sample(s)outside temperature criteria (PMIAPM 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 Initial: <br /> CU <br /> SDY SEALS INTACT: <br /> OCooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ NIA Initial: <br /> ❑ Sample ❑ ❑ No (Not Intact) Not Present Initial: <br /> SAMPLE CONDITION: Yes No NIA <br /> Chain-Of-Custody(COC) document(s) received with samples................... © ❑ <br /> COC document(s) received complete................................................... �' ❑ ❑ <br /> ❑ Collection dateltime, 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...................................................... ❑ ❑ <br /> Sample container label(s) consistent with COC...................................... ❑ ❑ <br /> Sample container(s) intact and good condition.......................................rte ❑ ❑ <br /> Proper containers and sufficient volume for analyses requested................ P" ❑ ❑ <br /> Analyses received within holding time.................................................. lz� ❑ ❑ <br /> pH 1 Res. Chlorine I Diss. Sulfide 1 Diss. Oxygen received within 24 hours... ❑ ❑ <br /> Proper preservation noted on COC or sample container.......................... ❑ ❑ �' <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: 04ozCGJ 08ozCGJ ❑16ozCGJ Sleeve ( S ) ❑EnCoreso ❑TerraCores° ❑ <br /> Water: ❑VOA ❑VOAh ❑VOAna2 0125AGB 0125AGBh 0125AGBp 01AGB 01AGBna2 ❑1AGBs <br /> ❑500AGB 0500AGJ 0500AGJs 0250AGS 0250CGB 0250CGBs 01PB ❑500PB 0500PBna <br /> ❑250PB 0250PBn 0125PB 0125PBznna 0100PJ 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:Battle Z:ZiploctResealable Bag E:Envelope Reviewed by: <br /> Preservative: h:HCL n:HNO3 nae:Na2s203 na:NaOH p:H3PO4 s:H2SO4 znna:ZnAcz+NaOH f:Field-filtered Scanned by: <br /> 50P T100_090(03124111) <br />