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Page 8 of 8 WORK ORDER #: 12=12-0 E � ttx • Cooler --(- of CLIENT: k( EE DATE: 12 /5-2.112 TEMPERATURE: Thermometer ID: SC4 (Criteria: 0.0°C—6.0°C, not frozen except sediment/tissue) Temperature f . g °C - 0.3°C (CF) = 1 °C .:"Blank ❑ 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. v Ambient Temperature: ❑ Air ❑ Filter Initial: t C, CUSTODY SEALS INTACT: ,Cooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: ❑ Sample ❑ ❑ No (Not Intact) mot Present Initial: .�4 SAMPLE CONDITION: Yes No N/A Chain-Of-Custody(COC) document(s) received with samples.................. ❑ ❑ COC document(s) received complete....................................................?T ❑ ❑ ❑ 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...................................................... ❑ ❑ 2111" 00 E Sample container label(s) consistent with COC......................................'a ❑ ❑ Sample container(s) intact and good condition.......................................-[1- ❑ ❑ Proper containers and sufficient volume for analyses requested.................T. ❑ ❑ Analyses received within holding time.................................................. iT ❑ ❑ pH / Res. Chlorine/ Diss. Sulfide / Diss. Oxygen received within 24 hours... ❑ ❑ J21' Proper preservation noted on COC or sample container..........................'a ❑ ❑ ❑ Unpreserved vials received for Volatiles analysis Volatile analysis container(s)free of headspace..................................... ❑ ❑ Tedlar bag(s)free ofcondensation...................................................... ❑ ❑ CONTAINER TYPE: Solid: ❑4ozCGJ 08ozCGJ 177116ozCGJ ❑Sleeve ( ) ❑EnCores° ❑TerraCoreso ❑ Water: ❑VOA ❑VOAh' ❑VOAna2 0125AGB 0125AGBh 0125AGBp 01AGB 01AG13na2,n'1AGBs 1771500AG13 ❑500AGJ 0500AGJs 0250AGB ❑250CGB 0250CGBs 01P13 ❑1PBna 0500PB ❑250PB ❑250PBn 0125PB ❑125PBznna ❑100PJ 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(11/20112)