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A9H1897 08/14/2019 <br /> BSK Associates SR-FL-0002-20 atias8200 10 <br /> Sample Integrity IIII III) III II IIS �I II <br /> BSK Bottles: Yes No Page of <br /> Is temperature within range. Ye No NA Are correct containers and preservatives No NA <br /> Chemistry 5 6°C Micro<8°C received for the tests requested? <br /> o If samples were taken today, is there evidence Yes No A Bubbles Present in VOA(524.2/TCPfTTHM)? Yes No N1_ <br /> = that chillinghas begun? TB Received? Check Method Below Yes No <br /> V Did all bottles arrive unbroken and intact? Yes I No Is sufficient amount of sample received? ('Yes No <br /> Do all bottle labels agree with COC? Yes No Do samples have a hold time<72 hours? Yes o <br /> Was sodium thiosulfate added to CN sample(s) Has PM been notified of discrepancies? Yes No N <br /> until chlorine was no longer present? Yes No A PM: By/Time: <br /> 250ml(A)500ml(B) 1Liter(C)40mlVOA(V) 125ml(D) Checks Passed? <br /> Bacti Na2S203 — — <br /> None (p)White cap — — <br /> Cris(P)Lt Green Label/Blue Cap NH40H(NH4)2SO4 DW Cl,pH>8 P F <br /> Cr6 (P) Pink LabellBlue Cap NH40H(NH4)2SO4 WW pH 9.3-9.7 P F <br /> _m <br /> a� Cr6 (P) Black Label/Blue Cap NH40H(NH4)2SO4 7199 <br /> pH 9.0-9.5 P F <br /> —*24 HOUR HOLD TIME'"' <br /> c_ <br /> -a HNO3 (P)Red Cap or HCI (P) Purple Cap!U Blue Label — — <br /> CD <br /> FE H2SO4 (P) or (AG) Yell—cap/Labol pH <2 P F <br /> a) NaOH (P)Green Cap CI, pH >10 P F <br /> o NaOH+ZnAc(P) pH>9 P F <br /> 8 Dissolved Oxygen 300ml (g) — <br /> Z None(AG)608/8081/8082,625,63218321,8151,8270 <br /> a� <br /> L HCI (AG)u.BWe Label O&G,Diesel,TCP — — <br /> (17 <br /> N � <br /> cu Ascorbic, EDTA, KH2Ct(AG)Pir*Labs' 525 — — <br /> N Y Na2SO3 250mL (AG)Neon Green Label 515 — — <br /> °' s Na2S2031 Liter(Brown P)549 — — <br /> U — — <br /> � Na2S203(AG)Blue Label 548,THM,524 <br /> t Na2S203(CG)Blue Label 504,505,547 — <br /> Na2S203+ MCAA(CG)OrangeLabel 531 pH <3 P F <br /> z NH4CI(AG)Purm-Laeel 552 — — <br /> cO EDA(AG)Brown Label DBPS — — <br /> �, HCL(CG)524.2,BTEX,Gas,MTBE,8260/624 — <br /> c <br /> a Buffer pH 4 (CG) — <br /> EH3PO4(CG)salmon Label — <br /> =� Trizma–EPA 537.1 <br /> Other: •</' Sew- <br /> Asbestos <br /> am -Asbestos 1 L (P)w/Foil / LL Metals Bottle — — <br /> Bottled Water — — <br /> Clear Glass 125mL/250ml-/500ml- / 1 Liter — — <br /> Solids: Brass / Steel / Plastic Ba — — <br /> �, Container Preservative Date/Time/Initials Container Preservative Date/Time/Initials <br /> p, S P S P <br /> S p S P <br /> Indicates Blanks Received <br /> 504 _ 524.2 _ TCP_ TTHM_ 537 <br /> 0 <br /> E <br /> E 8260/624 <br /> 0 <br /> U <br /> Scanned: <br /> Page 10 of 16 <br />