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Section I —Sample Arrival Information <br />Sample Transport: ONTRAC UPS USPS I1 EXCELCHEM Courier Fed-Ex Other: <br />Transported In: Hand <br />Packing materia Foam Packing Peanuts Paper Other: <br />Has chilling proc <br />Temperature of Samples (CC): 3 , <br />Samples Received: Chilled to Touch / Ambient Ice <br />Ice Chest Temperature(s) (CC): 5 <br />damage to summa canisters or flow regulators? Explain. al <br />Section 3 —Surama/Flow regulator In <br />Unused Summa#: <br />Cleaning Summa#: <br />Regulatora: <br />Was there <br />Date:, Filled out by: <br />Time: / <br />MBA JVSbC,11,,, <br />Odor Dissolved Oxygen <br />/SHORT HOLD LIST (<72 hours <br />Chlorine Corrosivirv <br />Settable Solids <br />Coliform <br />Turbidity Biochemical Oxygen DZmand <br />Nitrate <br />Color <br />Nitrite <br />'redlars <br />Ortho-phosphate <br />Ammonia/11<N (unprescrved) <br />al <br />11PC <br />Section 5 — Comments / Discrepancies <br />Client notified of discrepancies: Yes /No Notified by: <br />Comments: <br />Bin Number/ Location: <br />ik <br />COC Scanned/Attached by: t2S <br />Samples labeled by: S. <br />Sample labels reviewed by: <br />Excelchem Laboratories, Inc. <br />Ancon Environmental Project: TSS/Ranjeet Singh <br />570 Business Park Dr. Project Number: 400-13-30024 Date Reported: <br />Lincoln, CA 95678 Project Manager: Jason Morgan 12/08/20 17:38 <br />Sample Integrity WORK ORDER: .2011 <br />Company Name: <br />Date Received: ) — 2 -- New Client: Y <br />Section 2 — Bottle/Analysis Info. <br />N..... No N 1 Comments <br />Did all bottles arrive unbroken and intact? <br />Did all all bottle labels agree with COC? <br />-.."--- <br />Were correct containers used for the tests requested? <br />Were correct preservations used for the tests requested? <br />Was a sufficient amount of sample sent for tests indicated? <br />Were bubbles present in VOA Vials?: (Volatile Methods Only) <br />Section 4— COC Information <br />Yes No Comments Yes No Comments <br />COC Received Analysis Requested _----- <br />Date Sampled - Samples arrived within holding time <br />Hold times less than 72 hours <br /> <br />Time Sampled . <br />Sample ID Client Name <br />Rush Turn Turn Around Time - c? 12,. / Client Contact Information <br />F.xcelchem Laboratories. Inc. The results in this report apply to the samples analyzed in accordance with the chain of <br />custody document. This analytical report must be reproduced in its entirety. <br /> <br />Laboratory Representative Page 2 of 2