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Section I — Sample Arrival Information <br />Sample Transport ONTRAC UPS <br />Transported In: Ice Chest Box <br />Packing materials: Bubble Wrap <br />Has chilling process begun? <br />Temperature of Samples ("C): <br />we, <br />EXCELCHEM Courier Fed-Ex Other_ <br />Packing Peanuts Paper <br />Samples Received: C <br />lee Chest 'Temperatts <br />uch / Ambient / .On Ice <br />s ("C): <br />LTSPS <br />Foam <br />No Yes <br />Section 3— COC Information <br />No Comments <br />VIAA<IP, <br />Analysis Requested <br />Samples arrived within holding time <br />Yes <br />ptl Chlorine Corronythe Confirm, <br />.."5 nil-IR • ill/Lon, •-•....1. a 5 - • m ..........., <br />De:solved Oxygen Odor Nitrate Nitrite Ortho-phosphate <br />AmmoniniTKN iuntnesennttd) <br />MB Asbestos Settable Solids <br />As <br />Turbidity Biochemical Oxygen Demand HPC Color Thaler. <br />COC Received <br />Date Sampled <br />Time Sampled <br />Sample ID <br />Rush Turn Around Time <br />Hold times less than 72 hours <br />Client Name <br />Client Contact information <br />Section 4— Comments / Discrepancies <br />Client notified of discrepancies: Yes I No Notified by: <br />Comments: <br />Bin Number ,. I.. oeution.: A - ?t4 <br />I .(X Scanned/Attached hr <br />CS <br />Sample, labeled by S5 <br />Sample labels 'evict...id by. ..1-, <br />Date:Lm t4124. <br />Time: <br />[Filled out by: <br />Excelchem Laboratories, Inc. <br />Ancon Environmental <br />570 Business Park Dr. <br />Lincoln, CA 95678 <br />Project: <br />Project Number: <br />Project Manager: <br />LMH Lathrop <br />1050228 <br />Nolan Ryan <br />Date Reported: <br />04/20/21 17:14 <br />Sample Integrity WORK ORDER: Ot--100 <br /> <br />Date Received: LI 1\742 i <br /> <br />Company Name: <br />New Client: <br /> <br />Section 2 — Hottle/Anatysis info. <br />Yes No St:A Comments <br />Did all bottles arrive unbroken and intact? <br />Did all bottle labels agree with CDC? <br />Were correct containers used for the tests requested'? <br />Were correct correct preservations used for the tests requested? •••pc - <br />Was a sufficient amount of sample sent for tests indicated? ''>'" <br />Were bubbles present in VOA Vials?: (Volatile Methods Only) <br />Is there head space in the VOA vials? (Volatile Methods Only) <br />Excelchem Laboratories. Inc. <br /> <br />The mulls in this report apply to the samples analyzed in accordance with the chain of <br />custody document. This analytical report must he reproduced in its entirety. <br /> <br />Page 2 of 2 <br />Laboratory Representative