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tiati e U i0f I h S WORK ORDER NUMBER: 1g� of,1Q Cals ience �C/J SAMPLE RECEIPT CHECKLIST COOLER _ OF CLIENT: ' Gt DATE: 10 / 6)f2017 TEMPERATURE: (Criteria: 6.0°C — 6.0°C, not frozen except sediment/tissue) Thermometer ID: SC6 (CF: .4°C); Temperature (w/o CF): 7i: k °C (w/ CF): � 4 °C; -0'81ank ❑ 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: CUSTODY SEAL: Cooler y� present an 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: WS i SAMPLE CONDITION: ) noted on COC and/or sample container .................................... Yes No N/A Chain -of -Custody (COC) docbment(s) received with samples ................................................... 0/ ❑ ❑ COC document(s) received cbmplete ................................................................................. g ❑ ❑ ❑ Sampling date ❑ Sampling time ❑ Matrix ❑ Number of containers f ❑ Carbon Dioxide (SM 450 ❑Ferrous Iron (SM 3500) ❑Hydrogen Sulfide (Hach) ❑ No analysis requested ❑ Not relinquished ❑ No relinquished date ❑ No relinquished time sation................................................................................. / ❑ ❑ Pt CONTAINER TYPE: Sampler's name indicated on COC ......................... ❑ ❑ Ef-l. Sample container label(s) cor sistent with COC .............. ... ."t ................... .p„ ........ 0, ❑ ❑ Sample container(s) intact an J in good condition .........................l7EC'2 U 2017 ............................... 17, El 13 Proper containers for analyse requested........................................................................... Labeled/Checked by: Or ❑ ❑ Sufficient volume/mass for an lyses requested.............. ENVIRON h'FrlVl'AL ...EALTH ...... �H ❑ ❑ Samples received within holdi g time .................................... M!7._.....,�, �NT.................... � ❑ ❑ Aqueous samples for certa n analyses received within 15 -minute holding time ❑ pH ❑ Residual Chlorin ❑ Dissolved Sulfide ❑ Dissolved Oxygen .............................. ❑ ❑ 21❑ 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 ..................................................... ❑ ❑ Container(s) for certain analys s free of headspace.................................................................. ❑ ❑ ❑ Volatile Organics ❑ Di solved Gases (RSK-175) ❑ Dissolved Oxygen (SM 4500) ❑ Carbon Dioxide (SM 450 ❑Ferrous Iron (SM 3500) ❑Hydrogen Sulfide (Hach) TedlarT"' bag(s) free of condensation sation................................................................................. / ❑ ❑ Pt CONTAINER TYPE: (Trip Blank Lot Number: ) Aqueous: ❑ VOA ❑ VOAh ❑ V Ana2 ❑ 100PJ ❑ 100PJna2 ❑ 125AGB ❑ 125AGBh ❑ 125AGBp ❑ 125PS ❑ 125PBznna (pH_9) ❑ 250AGB ❑ 250CGB ❑ 250CGps (pH_2) ❑ 250PB ❑ 250PBn (pH_2) ❑ 500AGB ❑ 500AGJ ❑ 500AGJs (pH_2) ❑ 500PB 1AGBna2 ❑ 1AGBs (pH_2) ❑ 1AGBs (O&G) ❑ 1PB ❑ 1PBna (pH_12) 13 ❑ 1AGV4ozCGJ 11Solid: ❑ 8ozCGJ ❑ 1�ozCGJ ❑ Sleeve (__) ❑ EnCoreso (_) ❑ TerraCoree (_) ❑ ❑ ❑ Air. ❑ TedlarT" ❑ Canister ❑ S*ent Tube ❑ PUF ❑ Other Matrix ( ): ❑ ❑ ❑ Container: A = Amber, B = Bottle, 6 = Clear, E = Envelope, G = Glass, J = Jar, P = Plastic, and Z = Ziploc/Resealable Bag Preservative: b = buffered, f = filteIied, h = HCl, n = HNO3, na = NaOH, nae = Na2S203, p = H3PO4, Labeled/Checked by: Or s = H2SO4, u = ultrapure, x = Na2SO3+NaHSO4.H2O, znna = Zn (CH3CO2)2 + NaOH Reviewed Pyg 2017-08-29 Revision