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••• • • Receipt • Client Name: Project #: :1 0521 947 A1,6o wi. PM: TJS Due Date: 06/25/20 Courier: [Fed Ex ❑UPS ❑USPS ❑Client CLIENT: AECOM—CA Pace ❑SpeeDee ❑Commercial see Exceptions Tracking Number: Q)14 l Ska 1 7 4, 13 b ❑ Custody Seal on Cooler/Box Present? Nyes ❑No Seals Intact? ' fes ❑No Packing Material: [pubble Wrap �ubble Bags ❑None J Dther: F!3 71(0461) ❑ T2(1336) ❑T3(0459 Biological Tissue Frozen? ❑]Ye"s [—]No Ekjo , Temp Blank? �(es ❑No Thermometer: M T41n7Sai F1 TSrnastai ) Type of Ice: *et ❑Blue ❑None ❑Dry ❑Melted Did Samples Originate in West Virginia? ❑YesEk Were All Container Temps Taken? ❑Yes ❑No /A Document Name: Document Revised: 27Mar2020 aceAnalytical ® Sample Condition Upon Receipt (SCUR) - MN Page 1 of 1 Document No.: Pace Analytical Services - - ENV-FRM-MIN4-0150 Rev.00 Minneapolis ••• • • Receipt • Client Name: Project #: :1 0521 947 A1,6o wi. PM: TJS Due Date: 06/25/20 Courier: [Fed Ex ❑UPS ❑USPS ❑Client CLIENT: AECOM—CA Pace ❑SpeeDee ❑Commercial see Exceptions Tracking Number: Q)14 l Ska 1 7 4, 13 b ❑ Custody Seal on Cooler/Box Present? Nyes ❑No Seals Intact? ' fes ❑No Packing Material: [pubble Wrap �ubble Bags ❑None J Dther: F!3 71(0461) ❑ T2(1336) ❑T3(0459 Biological Tissue Frozen? ❑]Ye"s [—]No Ekjo , Temp Blank? �(es ❑No Thermometer: M T41n7Sai F1 TSrnastai ) Type of Ice: *et ❑Blue ❑None ❑Dry ❑Melted Did Samples Originate in West Virginia? ❑YesEk Were All Container Temps Taken? ❑Yes ❑No /A Temp should be above freezing to 6°C Cooler Temp Read w/temp blank: 1.6 °CAverage Corrected Temp Correction Factor: Cooler Temp Corrected w/temp blank: 0 - ``7 °C (no temp blank only): ❑See Exceptions °C ❑1 Container USDA Regulated Soil: ( ❑ N/A, water sample/Other: Date/Initials of Person Examining Contents: 611 (0/ le t Z49 1 Did samples originate in a quarantine zone within the United State • CA EL, GA, Did samples originate from a foreign source (internationally, including ID, LA. MS, NC, NM, NY, OK, OR, SC, TN, TX or VA (check maps)? es I � all nd Puerto Rico)? [:]Yeso If Yes to either question, fill out a Regulat Checklist 0N -Q-334 and include with SCUR/COC pape ork. CLIENT NOTIFICATION/RESOLUTION Person Contacted: Comments/Resolution: I Date/Time: Field Data Required? ❑Yes ❑No Project Manager Review: -,�ax, Date: 06/18/20 Note: Whenever there is a discrepancy affecting North Carolina comfOiance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office( Le out of hold, incorrect preservative, out of temp, incorrect containers). P.0 of 22 Labeled by: COMMENTS: Chain of Custody Present and Filled Out? Myes ❑No 1. Chain of Custody Relinquished? Mves ❑No 2. Sampler Name and/or Signature on COC?Yes ❑No [-]N/A 3. Samples Arrived within Hold Time? es ❑No 4. F. Short Hold Time Analysis (<1`2 hr)? ❑Yes �60 S. ❑Fecal Coliform ❑HPC ❑Total Coliform/E coli ❑BOD/cBOD ❑Hex Chrome ❑Turbidity ❑Nitrate ❑Nitrite ❑Orthophos ❑Other Rush Turn Around Time Requested? Mes []No 6. Sufficient Volume? Yes ❑No 7. Correct Containers Used? Ikyes ❑No 8. -Pace Containers Used? t&es ❑No Containers Intact? es ❑No 9. Field Filtered Volume Received for Dissolved Tests? []Yes ❑No /A 10. Is sediment visible in the dissolved container? ❑Yes [:]No Is sufficient information available to reconcile the samples 11. If no, write ID/ Date/Time on Container Below: See Exception to the COC? Ees ❑No ❑ Matrix: ❑Water oil ❑Oil [-]Other All containers needing acid/base preservation have been ❑Yes_❑No `PN/A— 12. Sample # checked? All containers needing preservation are found to be in [-]Yes ❑No 1W/A ❑ NaOH ❑ HNO3 ❑1-12SO4 ❑Zinc Acetate compliance with EPA recommendation? (HNO3, H2SO4, <2pH, NaOH >9 Sulfide, NaOH>12 Cyanide) Positive for Res. ❑Yes See Exception Exceptions: VOA, Coliform, TOC/DOC Oil and Grease, ❑Yes [:]No /A Chlorine? [-]No pH Paper Lot# ❑ DRO/8015 (water) and Dioxin/PFAS Res. Chlorine 0-6 Roll 0-6 Strip 0-14 Strip Extra labels present on soil VOA or WIDRO containers? Nyes ❑No ❑N/A 13. See Exception Headspace in VOA Vials (greater than 6mm)? ❑Yes [:]No /A ❑ Trip Blank Present? ❑Yes10 N/A 14. No 7� V-uz . Trip Blank Custody Seals Present? ❑Yes No A Pace Trip Blank Lot # (if purchased): CLIENT NOTIFICATION/RESOLUTION Person Contacted: Comments/Resolution: I Date/Time: Field Data Required? ❑Yes ❑No Project Manager Review: -,�ax, Date: 06/18/20 Note: Whenever there is a discrepancy affecting North Carolina comfOiance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office( Le out of hold, incorrect preservative, out of temp, incorrect containers). P.0 of 22 Labeled by: