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Page 29 of 32 <br /> . :., WORK ORDER M 11 -07-0 0 ® 1 <br /> ' Cooler of 11 <br /> CLIENT: DATE: 0712-1111 <br /> TEMPERATURE: Thermometer ID: SC1 (Criteria: 0.0°C—6.0°C, not frozen) <br /> Temperature 2 °C + 0.5°C (CF)g = °C 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 Initial: <br /> CUSTODY SEALS INTACT: <br /> ❑ Cooler ❑ ❑ No (Not Intact) V<ot Present ❑ N/A Initial: 1 <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...................01, ❑ ❑ <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...................... .............................. 13 ❑ <br /> U <br /> 0 <br /> Sample container label(s) consistent with COC............ .....01' ❑ ❑ <br /> Sample container(s) intact and good condition....................................... 011' ❑ ❑ <br /> Proper containers and sufficient volume for analyses requested................ ❑ ❑ <br /> Analyses received within holding time.................................................. P� ❑ ❑ <br /> pH / Res. Chlorine/ Diss. Sulfide/ Diss. Oxygen received within 24 hours... ❑ ❑ <br /> Proper preservation noted on COC or sample container.......................... 2( ❑ p <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s) free of headspace......................................❑ ❑ CJS <br /> Tedlar bag(s) free of condensation...................................................... ❑ ❑ <br /> CONTAINER'TYPE: <br /> Solid: ❑4ozCGJ ❑8ozCGJ 016ozCGJ ❑Sleeve ( ) ❑EnCorese ❑TerraCores° El <br /> Water: ❑VOA '❑VOAh ❑VOAna2 ❑125AGB 0125AGBh 11125AGBp AGB '/ 2 131AGBs <br /> ❑500AGB' 7500AGJ 1771500AGJs ❑250AGB ❑250CGB ❑250CGBs 131PB ❑500PB 0500PBna <br /> ❑250PB 7250PBn 0125PB 0125PBznna 0100PJ ❑100PJna2 ❑ ❑ <br /> Air: ❑Tedlar° ❑Summa° Other: ❑ Trip Blank Lot#: Labeled/Checked by: <br /> AH- <br /> Container: C:Clear A:Amber P: Plastic G:Glass J:Jar B:Bottle Z:Ziploc/Resealable Bag E:Envelope Reviewed by � . . <br /> Preservative:' h:HCL n:HNO3 na2:Na2S203 na NaOH p:H3PO4 s:H2SO4 znna:ZnAc2+NaOH f:Field-filtered Scanned by: <br /> SOP T100090(03124111) <br />