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Page 8 of 8 WORK ORDER #: 12 -® 0 rboratorietsdAc. Cooler of CLIENT: l/( rF DATE: 2-8112 TEMPERATURE: Thermometer ID: SC4 (Criteria: 0.0°C—6.0°C, not frozen except sediment/tissue) Temperature I . q-_°C - 0.3°C (CF) = I . ( °C RrBlank ❑ 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: CUT SEALS INTACT: Cooler ❑ ❑ No (Not Intact) ❑ Not Present ❑N/A Initial: ❑ Sample ❑ ❑ No (Not Intact) 2- of Present Initial: SAMPLE CONDITION: Yes No N/A Chain-Of-Custody (COC) document(s) received with samples................... ❑ ❑ COC document(s) received complete................................................... 2-, ❑ ❑ ❑ 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.................... ................................. ❑ ❑ o Sample container label(s) consistent with COC...................................... ❑ ❑ Sample container(s) intact and good condition....................................... ❑ ❑ Proper containers and sufficient volume for analyses requested................ i ❑ ❑ Analyses received within holding time.................................................. ❑ ❑ pH /Res. Chlorine`/ Diss. Sulfide / Diss. Oxygen received within 24 hours... ❑ ❑ Proper preservation noted on COC or sample container.......................... Jam ❑ ❑ ❑ Unpreserved vials received for Volatiles analysis Volatile analysis container(s) free of headspace..................................... ❑ ❑ P1� Tedlar bag(s)free of condensation...................................................... ❑ ❑ K� CONTAINER TYPE: Solid: ❑4ozCGJ ' 08ozCGJ 1116ozCGJ ❑Sleeve ( ) ❑EnCorese ❑TerraCoreso ❑ Water: ❑VOA ❑VOAh ❑V0Ana2 ❑125AGB 0125AGBh 0125AGBp 01AGB ❑1AGBna2 1AGBs 0500AGB ❑500AGJ 11500AGJs ❑250AGB 0250CGB ❑250CGBs ❑1PB 01PBna 0500PB ❑250PB` 0250PBn 0125PB 1:1125PBznna 0100PJ 0100PJna2 ❑ ❑ ❑ Air: ❑Tedlar°' ❑Canister 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:Na2S203 na:NaOH p:H3PO4 s:H2SO4 u:Ultra-pure znna:ZnAc2+NaOH f:Filtered Scanned by: SOP T100_090(11/20/12)