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AFJ2735 F'GLFn2b()0 10119/2022 <br /> B5K Associates 5R-FL-0002-23 - <br /> Sample Integrity <br /> BSK Bottles: es No Page of <br /> Was temperat rn range? Yes No NA Were correct containers and preservatives Yes o NA <br /> Chemist 5$'C Micro<8'C received for the tests requested? <br /> If samples were taken today,is there evidence Bubbles Present VOAs(524.21TTHMlTCP)? Yes NA <br /> that chillinghas begun? Yes No NA TB Received? Check Method Below Y NA <br /> ODid all bottles arrive unbroken and intact? No Was a sufficient amount of sample received? <br /> U Did all bottle labels agree with COC? Y s No Do samples have a hold time<72 hours? Yes No <br /> Was sodium thiosulfate added to CN sample(s) Yes �AMWas PM notified of discrepancies? Yes No NA <br /> until chlorine was no longer present? PBylTime: <br /> 250m1(A)500mi(B) iLRer(C)40mIVOA(%o 125mi(D) Checks* Passed? <br /> Bacti Na2S203 — — <br /> None Tffl'ceCap — — <br /> Cr6(P)Ll.Green LabeUBlue Cap NH40H(NH4)2SO4 #)W Cl,pH'8 P F <br /> Cr6 (P) Pink Labels lue Cap NH40H(NH4)2SO4 WW pH 9.3-9-7 P F <br /> Cr6 (P) Black Label/Blue cap NH40H(NH4)2SO4 7199 <br /> c —24 HOUR HOLD TIME' pH 9.0-9.5 P F <br /> HNO3(P)Red I-P or HCI(P)Purple Caprij.Skm Label <br /> H2SO4 (P) or (AG) Yellow capA-abel pH a 2 P F <br /> cL NaOH (P)Green cap Cl,PH n10 P F <br /> m NaOH+ZnAc(P) PH a 9 P F <br /> 0 <br /> Dissolved Oxygen 300ml (g) — — <br /> -a w None(AG)emsoaltoo82,625,632!8321,61st,atm — <br /> QI t <br /> "t HCI (AG)u.Blue Label Og,O Diesel,TCP — — <br /> ro Ascorbic, EDTA, KH2Ct(AG)Pl"l,LaW 525 —En <br /> -- <br /> Na2SO3 250ml-(AG)Neon Green Label 515 — — <br /> 0 a) <br /> Na2S2031 Liter(Brown P)549 — — <br /> 0 .� Na2S203(AG)Blue Label 548,THM.524 — — <br /> 0 <br /> Na2S203(CG)Blue Lebel 504.505,547if <br /> — — <br /> o Na2S203+ MCAA(CG)orange Label 531 pH<3 P F <br /> ca <br /> y NH4CI (A(3)PuryleLabel 552 — — <br /> 2 EDA(P) or (AG)Brown Label DBPs — — <br /> 1 HCL(CG)524.2,BTEX,Gas,MTBE,8260/624 — — <br /> Buffer pH 4(CG) — — <br /> _� H3PO4(CG)�'-- -- — <br /> Trizma–EPA 537.1 -Field Blank Re ulred <br /> Other: <br /> Asbestos 1 L (P)w/Foil 1 LL Metals Bottle — — <br /> Bottled Water — — <br /> Clear Glass — <br /> Solids: Brass 1 Steel / Plastic Ba — — <br /> Container Preservative Lot# Initials DateMme Preservation Check <br /> CL S P pH Lot# <br /> Cn <br /> S P Ci Lot # <br /> *Preservation check completed by lab performing analysis. ✓ Indicates Blanks Received <br /> 504_ 524.2 _ TTHM_ 537.1 _ TCP_ <br /> E <br /> ✓ MSIMSD Received Method: <br /> Scanned: Rush/Short HT Page Time: <br /> Page 9of9 <br />