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Page 16 of 16 =nmeAw WORK ORDER #: 10-12-© 0 0 El Vwl"o ' N Cooler of CLIENT: DATE: 92 AA / 10 TEMPERATURE: Therrol ometer ID: SC1 (Criteria: 0.0°C—6.0°C, not frozen/ Temperature °C + 0.5°C (CF) = 2 °C 0 Blank ❑ Sample ❑ Sample(s)outside tenj�perature 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: ` AAl/ CUSTODY SEALS IN ' CT: ❑ Cooler ❑ ❑ No (Not Intact) Zot Present ❑ N/A Initial: n ❑ Sample ❑ ❑ No (Not Intact) Present Initial: Vim% t Yes/ No N/A Chain-Of-Custody lyy (CIOC);document(s) received with samples................... ❑ ❑ 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. / Sampier's name indicated on COC..................................................... a ❑ ❑ Sample container label(s);consistent with COC..................................... 2---, ❑ ❑ Sample container(s) intact and good condition...................................... C?-' ❑ ❑ Proper containers and sufficient volume for analyses requested............... 2__1__ ❑ ❑ Analyses received within holding time................................................. ;R,-, ❑ ❑ pH / Residual Chlorine/ Qissolved Sulfide received within 24 hours........... ❑ ❑ C� Proper preservation noted on COC or sample container.......................... ❑ ❑ ❑ Unpreserved vials received for Volatiles analysis Volatile analysis containem(s)free of headspace..................................... ❑ ❑ p� Tedlar bag(s)free of cont(ensation...................................................... ❑ ❑ CONTAINER TYPE: Solid: ❑4ozCGJ ❑8ozCGJ ❑16ozCGJ [Sleeve ( - ) ❑EnCores° ❑TerraCoreso ❑ Water: ❑VOA ❑VOAh EJVOAna2 0125AGB ❑125AGBh 13125AGBp 01AGB ❑1AGBna2 ❑1AGBs 11500AGB 0500AGJ 0500AGJs ❑250AGB 1:1250CGB 0250CGBs 1__I1PB 11500PB 13500PBna 0250PB ❑250PBn ❑12'5PB ❑125PBznna ❑100PJ ❑100PJna2 ❑ ❑ ❑ Air: ❑Tedlaro ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by: / 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:Na2S2O3 na:NaOH p:H3PO4 s:H2SO4 znna:ZnAc2+NaOH f:Field-filtered Scanned by: SOP T100_090(09113/10)