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Cmet Page 33 of 34 <br /> �*=hronillnelnial WORK ORDER #: 10-12411 ® © Q <br /> Laboratories, Inc. <br /> 2 � Cooler / of -�- <br /> CLIENT: 1371 DATE: 12 / Of/ 10 <br /> TEMPERATURE: Thermometer ID: SCI (Criteria: 0.0°C—6.0'C, not frozen) <br /> Temperature 0 . 9 OC + 0.5 OC (CF) = / . 2" OC E�'B lank ❑ 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 /> YJ Cooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: <br /> ❑ Sample ❑ ❑ No (Not Intact) ONot 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................................................ ..... ❑ ❑ <br /> Sample container label(s) consistent with COC..................................... ❑ ❑ <br /> Sample container(s) intact and good condition...................................... ❑ ❑ <br /> Proper containers and sufficient volume for analyses requested............... ❑ ❑ <br /> Analyses received within holding time................................................. )?!r, ❑ ❑ <br /> pH / Residual Chlorine / Dissolved Sulfide received within 24 hours........... ❑ ❑ <br /> Proper preservation noted on COC or sample container..........................X� ❑ ❑ <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s) free of headspace..................................... Z ❑ ❑ <br /> Tedlar bag(s) free of condensation...................................................... ❑ ❑ <br /> CONTAINER TYPE: <br /> Solid: ❑4ozCGJ ❑8ozCGJ ❑16ozCGJ ❑Sleeve ( ) ❑EnCoreso ❑TerraCoreso ❑ <br /> Water:XCA�?VOAIn ❑V0Ana2 ❑125AGB ❑125AGBh 0125AGBp ❑1AGB ❑1AGBna2 ❑IAGBs <br /> 0500AGB '�500AGJ 0500AGJs 0250AGB ❑250CGB ❑250CGBs 01PB ❑500PB ❑500PBna <br /> 0250PB 0250PBn ❑125PB ❑125PBznna ❑100PJ 11100PJna2 ❑ ❑ ❑ <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: . <A/ <br /> Preservative: h:HCL n:HNO3 na2:Na2S203 na:NaOH p:H3PO4 s:H2SO4 znna:ZnAC1+NaOH f:Field-filtered Scanned by: <Al <br /> SOP T100_090(09113/10) <br />