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ti'ti e u rof i n s WORK ORDER NUMBER: 1 Tgl V o?1—CT�L CaisFience SAMPLE RECEIPT CHECKLIST COOLER OF CLIENT: Gt DATE: 10 / 6 017 TEMPERATURE: (Criteria: O.0°C–6.0°C, not frozen except sediment/tissue) Thermometer ID: SC6 (CF: - .4°C); Temperature (w/o CF): k °C (w/CF): °C; flank ❑ Sample ❑ Sample(s) outside tem erature criteria (PM/APM contacted by: ) ❑ Sample(s)outside tem erature criteria but received on ice/chilled on same day of sampling ❑ Sample(s) received at am ient temperature; placed on ice for transport by courier Ambient Temperature: ❑ Air ❑ Filter Checked by: , L CUSTODY SEAL: Cooler resent and Intact ❑ Present but Not Intact ❑ Not Present ❑ N/A Checked by: Sample(s) ❑ Present and Intact ❑ Present but Not Intact _[2rNot Present ❑ N/A Checked by: IOS 7 SAMPLE CONDITION: Yes No N/A Chain-of-Custody(COC)doc ment(s) received with samples................................................... ❑ COC document(s) received c mplete ................................................................................. ❑ ❑ ❑ Sampling date ❑ Sam ling time ❑ Matrix ❑ Number of containers ❑ No analysis requested ❑ Not relinquished ❑ No relinquished date ❑ No relinquished time Sampler's name indicated on COC .................................................................................... ❑ ❑ Sample container label(s) co sistent with COC ..................................................................... 0, ❑ ❑ Sample container(s) intact an in good condition .................................................................. I, ❑ ❑ Proper containers for analyse requested ........................................................................... 0/, ❑ ❑ Sufficient volume/mass for an lyses requested ..................................................................... la/ ❑ ❑ Samples received within holdi g time ................................................................................. 0' ❑ ❑ Aqueous samples for certa n analyses received within 15-minute holding time ❑ pH ❑ Residual Chlorin ❑ Dissolved Sulfide ❑ Dissolved Oxygen ............ 16.. ❑ . w 7 01 Proper preservation chemical( ) noted on COC and/or sample container.................................... ❑ ❑ ❑ Unpreserved aqueous sam le(s) received for certain analyses ❑ Volatile Organics ❑ To al Metals ❑ Dissolved Metals Acid/base preserved samples pH within acceptable range ..................................F-MVIRONMEN AL f-0 .'ALTHL2(' Container(s)for certain analys s free of headspace............................................................mr lY��=�b ❑ Volatile Organics El Di solved Gases (RSK-175) ❑ Dissolved Oxygen (SM 4500) ❑ Carbon Dioxide (SM 450 ) ❑ Ferrous Iron (SM 3500) ❑ Hydrogen Sulfide (Hach) / TedlarTm bag(s)free of conde sation ................................................................................. ❑ ElPi CONTAINER TYPE: (Trip Blank Lot Number: ) Aqueous: ❑VOA ❑VOAh ❑V Anal 11100PJ ❑ 100PJna2 ❑ 125AGB ❑ 125AGBh ❑ 125AGBp ❑ 125PB 13125PBznna(pH_9) ❑250AGB ❑250CGB ❑250CG s(pH_2) ❑250PB ❑250PBn(pH_2) ❑500AGB ❑500AGJ ❑500AGJs(pH_2) ❑500PB ❑ 1AGV 1AGBna2 ❑ 1AGBs( H_2) ❑ 1AGBs(O&G)❑ 1P ❑ 1PBna(pH-12) 11 ❑ Solid: 4ozCGJ ❑ 8ozCGJ ❑ 1 ozCGJ ❑Sleeve L_) ❑ EnCorese(_) ❑TerraCoreso(_)❑ ❑ ❑ Air: ❑TedlarTl ❑Canister ❑So bent Tube ❑ PUF ❑ Other Matrix( ): ❑ ❑ ❑ Container: A=Amber, B= Bottle,IC= Clear, E= Envelope,G=Glass,J =Jar, P= Plastic, and Z=Ziploc/Resealable Bag Preservative: b= buffered,f=filtered, h= HCl, n= HNO3, na= NaOH, nae= Na2S203, p= H3PO4, Labeled/Checked by: r7r 3 s= H2SO4, u =ultralure,x= Na2SO3+NaHSO4.H2O, znna=Zn(CH3CO2)2+NaOH Reviewed Pyg 2017-08-29 Revision