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Page 7 of 8 - WORK ORDER #: 10-05- F21 ® ❑ FLI It W- � then Cooler of 1 CLIENT: -AKcc(04S DATE: 051®IlIO TEMPERATURE: Thermometer ID: SC1 (Criteria: 0.0°C—6.0°C, not frozen) Temperature Z Z °C + 0.5 OC (CF) = 2 . i—°C ZBIank ❑ 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: ❑ Cooler ❑ ❑ No (Not Intact) /Not Present ❑ N/A Initial: El Sample El No (Not Intact) I1'Not Present Initial: qt SAMPLE CONDITION: Yes No N/A Chain-Of-Custody (COC) document(s) received with samples..........:........ ❑ ❑ COC document(s) received complete.........................................:.........,e1 ❑ ❑ ❑ 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..................................................... ❑ ❑ Sample container label(s) consistent with COC..................................... ❑ ❑ Sample container(s) intact and good condition...................................... ❑ ❑ Proper containers and sufficient volume for analyses requested............... ❑ ❑ Analyses received within holding time................................................. /1 ❑ ❑ Proper preservation noted on COC or sample container........................ ❑ ❑ Unpreserved vials received for Volatiles analysis / Volatile analysis container(s) free of headspace...................................../11, ❑ ❑ Tedlar bag(s)free of condensation...................................................... ❑ ❑ CONTAINER TYPE: Solid: 74ozCGJ ❑8ozCGJ 016ozCGJ ❑Sleeve ( ) ❑EnCores° ❑TerraCores° ❑ Water: EIVOA /7rVOAh 0VOAna2 ❑125AGB ❑125AGBh ❑125AGBp ❑1 AGB ❑1 AGBna2 ❑1 AGBs 11500AGB ❑500AGJ ❑500AGJs ❑250AGB ❑250CGB ❑250CGBs ❑1PB ❑500PB ❑500PBna 11250PB 1:1250PBn ❑125PB 0125PBznna ❑100PJ ❑100PJna2 ❑ ❑ ❑ Air: ❑Tedlaro ❑Summa° Other: ❑ Trip Blank Lot#: COQ L4D 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:Na2S203 na:NaOH p:H3PO4 s:H2SO4 znna:ZnAC2+NaOH f:Field-filtered Scanned by: C SOP T100_090(07/16109)