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Page 29 of 29 VIVO vIrr7Fsi WORK ORDER #: 10-12-0 © El 'L abolraiolrfell, Inc.. � Cooler of � CLIENT': �C— � U��"�� DATE: 12 AA / 10 TEMPERATURE: Thermometer ID: SC1 (Criteria: 0.0°C—6.0°C, not frozen) / Temperature \ . a °C + 0.5°C (CF) = `L- . 4 °C Blank ❑ Sample ❑ Sample(s)outside temperature criteria (PM/APM contacted by: ). ❑ Sample(s)outside temperature criteria but received on ice/chilled on same day of sampling. ❑ Received at ambient temperature, placed on ice for transport by Courier. Ambient Temperature: ❑ Air ❑ Filter Initial: Vim/ CUSTODY SEALS INTACT: ❑ Ccoler ❑ ❑ No (Not Intact) � 13Present N/A Initial: ❑ Sample El EJ No (Not Intact) ;Zot Present Initial: SAMPLE CONDITION: Yes No N/A Chain-.0f-Custody (COC) document(s) received with samples................... 2---' ❑ ❑ COC document(s) received complete................................................... l� ❑ ❑ ❑ Collection date/time,matrix,and/or#of containers logged in based on sample labels. ❑ No analysis requested. ❑ Not relinquished. ❑ No date/time relinquished. / Sampler's name indicated on COC..................................................... Com/ ❑ ❑ Sample container label(s) consistent with COC..................................... / ❑ ❑ Sample container(s) intact and good condition...................................... C' ❑ ❑ Proper containers and sufficient volume for analyses requested............... tam ❑ ❑ Analyses received within holding time................................................. l:;� ❑ ❑ pH / Residual Chlorine/ Dissolved Sulfide received within 24 hours........... ❑ ❑ Proper preservation noted on COC or sample container.......................... ❑ ❑ 0� ❑ Unpreserved vials received for Volatiles analysis / Volatile analysis container(s)free of headspace..................................... ❑ ❑ Q Tedlar bag(s)free of condensation...................................................... ❑ ❑ CON'T'AINER TYPE: Solid- ❑4ozCGJ 1]8ozCGJ ❑16ozCGJ /Sleeve ( S ) ❑EnCorese ❑TerraCorese ❑ Water: ❑VOA ❑VOAh ❑V0Ana2 ❑125AGB 11125AGBh 0125AGBp 01AGB 131AGBna2 ❑1AGBs 0500AGB 0500AGJ 0500AGJs 0250AGB ❑250CGB 0250CGBs 01PB 0500PB 11500PBna 0250RB 11250PBn 0125PB ❑125PBznna 0100PJ 0100PJna2 ❑ ❑ ❑ Air: I❑Tedlar® ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by: U-0 container: C:Clear A:Amber P:Plastic G:Glass J:Jar B:Bottle Z:Ziploc/Resealable Bag E:Envelope Reviewed by: �_ Preservative: h:HCL n:HNO3 na2:Na2S203 na:NaOH p:H3PO4 s:HZSSO, znna:ZnAcz+NaOH f:Field-filtered Scanned by SOP T100_090(09113/10)