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Page 27 of 27 - WORK ORDER M 10-05- F21 10 . ... ...... . . ' Cooler of / CLIENT: qp,(C' i-3 DATE: 05101110 TEMPERATURE: Thermometer ID: SC1 (Criteria: 0.0°C—6.0°C, not frozen) Temperature o2 • 0 OC + 0.5°C (CF) = 02 ._Z_OC lank ❑ 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 ❑ Metals Only ❑ PCBs Only Initial CUSTODY SEALS INTACT: / 1:1Cooler ❑ ElNo (Not Intact) 2r Not Present ❑ N/A Initial: ❑ Sample ❑ ❑ No (Not Intact) Not Present Initial: �L SAMPLE CONDITION: Yes No N/A Chain-Of-Custody (COC) document(s) received with samples................... Wf ❑ ❑ COC document(s) received complete.........................................:........./P1 ❑ ❑ ❑ Collection date/time, matrix,and/or#of containers logged in based on sample labels. ❑ No analysis requested. ❑ Not relinquished. ❑ No date/time relinquished. 4 Sampler's name indicated on COC..................................................... ❑ ❑ Sample container label(s) consistent with COC..................................... /ZJ ❑ ❑ Sample container(s) intact and good condition...................................... l`J ❑ ❑ Proper containers and sufficient volume for analyses requested............... ❑ ❑ Analyses received within holding time................................................. 1 ❑ ❑ Proper preservation noted on COC or sample container.......................... ❑ ❑ l ❑ Unpreserved vials received for Volatiles analysis Volatile analysis container(s)free of headspace..................................... ❑ ❑ Tedlar bag(s)free of condensation...................................................... ❑ ❑ jd CONTAINER TYPE: Solid: /04ozCGJ ❑8ozCGJ ❑16ozCGJ ❑Sleeve ( ) ❑EnCoreso ❑TerraCorese ❑ Water: ❑VOA ❑VOAh ❑VOAna2 0125AGB ❑125AGBh ❑125AGBp ❑1AGB 01AGBna2 01AGBs 11500AGB ❑500AGJ ❑500AGJs ❑250AGB 0250CGB ❑250CGBs ❑1PB ❑500PB ❑500PBna ❑250PB ❑250PBn ❑125PB ❑125PBznna ❑100PJ ❑100PJna2 ❑ ❑ ❑ Air: ❑Tedlaro ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by: kC— SOP 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:Na2SZ03 na:NaOH p:H3PO4 s:HzSO4 znna:ZnAC2+NaOH f:Field-filtered Scanned by:T100_090(07/16/09)