Laserfiche WebLink
Page 19 of 20 <br /> WORK ORDER #: 11 -07-Fo <br /> Cooler of <br /> CLIENT: DATE: 07 /11 <br /> TEMPERATURE: Thermometer ID: SCI (Criteria: 0.0°C-6.0°C, not frozen) <br /> � <br /> Temperature ti °C + 0.50C (CF) _ �- Ar °C En) 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 /> F1 Received at ambient temperature,'placed`on ice for transport by Courier. <br /> Ambient Temperature: ❑ Air ❑ Filter Initial: <br /> CUSTODY SEALS INTACT: <br /> 2/cooler ❑ ❑No (Not Intact) ❑ Not Present ❑ N/A Initial: <br /> ❑ Sample ❑- ❑'.No (Not Intact) lot Present Initial: <br /> SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody (COC) document(s) received with samples................... ❑ ❑ <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.. .............................................. ❑ ❑ 0 <br /> Sample'container label(s) consistent with COC...................................... [30 2 <br /> Sample container(s) intact and good condition....................................... ❑ fid' ❑ <br /> Proper containers and sufficient volume for analyses requested................ i � ❑ ❑ <br /> Analyses received within holding;time. ................................................ l ❑ ❑ <br /> pH / Res. Chlorine/Diss. Sulfide/ Diss. Oxygen received within 24 hours... ❑ ❑ <br /> Proper preservation noted on COC or sample container.......................... 21_� ❑ ❑' <br /> ❑ Unpreserved vials received for Volatilesanalysis <br /> Volatile analysis container(s) free of headspace..................................... ❑ ❑ <br /> Tedlar bag(s) free of condensation...................................................... ❑ ❑ <br /> CONTAINER TYPE: <br /> Solid: ❑4ozCGJ 08ozCGJ 016ozCGJ ❑Sleeve ( ) ❑EnCorese ❑TerraCorese ❑ <br /> Water: ❑VOA ❑VOAh ❑VOAna2 171,125AG13 ❑125AGBh 0125AGBp ❑1AGB 9'iAGBna2 Errx Bs <br /> E1500AGB 0500AGJ 0500AGJs 0250AGB 13250CGB 0250CGBBs, 01PB ❑500PB ❑500PBna <br /> O50PB 0250PBn 0125PB 0125PBznna 0100PJ ❑100PJna2 ��l.-_Pj ❑ ❑ <br /> Air: ❑Tedlaro ❑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: <br /> Preservative: hr HCL n:HNO3 na2:Na2S203 na:NaOH p:H3PO4 s:H2SO4 znna:ZnAc2+NaOH f:Field-filtered Scanned by: <br /> SOP T100 090(03/24/11) <br />