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ENV-FRM-MIN4-0150 v19_Sample Condition Upon Receipt Person Examining&Date: /Z�� ' PROJECT#: WO# : 10740311 PM: IJJ Due Date: 07/07/25 CLIENT: Pace CA Client Name: ra&, Custody Seal Present: XYE.S ❑N Seals Intact: YES ❑NO - - --—----- --- Tracking Number: 11 See Exceptions form ENV-FRM-MIN4-0142. Courier: ❑Client ❑Commercial FedEx ❑Pace Courier/Field ❑SpeeDee ❑UPS ❑USPS Packing Material: ❑Bubble Bags ❑ Bubble g Wrap None ❑Other: Biological Tissue Frozen: ❑YES 0 0 Thermometer: ❑T1(0461) ❑T2(0431) ❑T3(0459) ❑T4(0402) Type of Ice: ❑Blue ❑Dry et ❑Melted ❑None ❑T5(0187) �,,R<T6(0396) ❑T7(0377) ❑T8(0775) ❑T9(0428) ❑01339252(0710) Temp Blank: ❑YES 0 NOTE:Temp should be S 6°C,but above freezing. Did Samples Originate in West Virginia: ❑YES 56iro(list temps on exception) Read Temp w/Temp Blank: °C Were All Container Temps Taken: ❑YES' ❑NO /A Correction Factor: a Aver a Corrected Temp(No Temp Blank Only): Corrected Temp w/Temp B k: °C See Exceptions form ENV-FRM-MIN4-0142. ❑1 Container USDA Regulated Soil:k2NIAater ample/Other(describe): Did Samples originate from dQeakfre following states(check maps): ❑YES NO Are samples from a foreign sour (international,including Hawaii Circle State: AL,AR,AZ,CA,FL,GA,ID,LA,MS,NC,NM,NY,OK,OR,SC,TN,TX,VA and Puerto Rico): ❑YES NO NOTE.If YES to either question fill out a Regulated Soil Checklist(ENV-FRM-MIN4-01S4J and include with SCUR/COc paperwork. LOCATION(check one): ❑DULLITH ' MINNEAPOUS ❑VIRGINIA YES NO" N/A COMMENT(S) Chain of Custody Present and Filled Out?(i.e.,Analysis/ID/Date/Time) ❑ 1. Chain of Custody Relinquished? ❑ 2. Sampler Name and/or Signature on COC? ❑ ❑ 3 Samples Arrived within Hold Time? ❑ 4 If Fecal: ❑<8 hrs ❑>8 hr but<24 hr ❑>24 hr Short Hold Time Analysis(<72 hr)? ❑ 5.❑BOD/cBOD ❑Fecal coliform ❑Hex Chrom ❑HPC ❑Nitrate ❑Nitrite ❑Ortho Phos ❑Total coliform/E.coli ❑Turbidity ❑Other: Rush Turn Around Time Requested? ❑ 6.❑Same Day ❑1 Day ❑2 Day ❑3 Day ❑5 Day Due Date: Sufficient Sample Volume?(If NO,list approximate volume 1n section 7.) ❑ 7. Correct Containers Used? ❑ ❑ 8 - Pace Containers Used? ❑ Containers Intact? ❑ 9 Field Filtered Volume Received for Dissolved Tests? 110 10. Is sediment visible in the dissolved container:❑YES ❑NO ID/Date/Time Match?(If NO fill out section 11.) ❑ ❑ 11. Matrix:❑Oil ❑Soil Water El Other ❑See Exceptions form ENV-FRM-MIN4-0142 All containers needing acid/base preservation have been checked? ❑ ❑ 12. Sample#: ❑HNO3 ❑H2SO4 ❑NaOH ❑Zinc Acetate PH Paper Lot#: ❑Residual Chlorine ❑0-6 Roll ❑0-6 Strip ❑0-14 Strip Positive for Residual Chlorine(NaOH containers only):❑YES ❑NO Preserved containers in compliance with EPA recommendations? ❑ ❑ ❑See Exceptions form ENV-FRM-MIN4-0142 (HNO3,H2SO4,<2 pH,NaOH>9 Sulfide,NaOH>30 Cyanide) EXCECTIONS(water only):VOA,Coliform,TOC/DOC,Oil&Grease,Phenols, ❑ ❑ DRO/8015,Dioxins,and PFAS Extra labels present on soil VOA or WIDRO containers?(soil only) ❑ ❑ 13. Headspace in Methyl Mercury Container? ❑ ❑ 14 Headspace in VOA Vials(greater than 6mm)? ❑ ❑ ❑See Exceptions form ENV-FRM-MIN4-0140 Trip Blanks Present? ❑ ❑ 15. Trip Blank Custody Seals Present? ❑ ❑ Pace Trip Blank Lot#(if purchased): CLIENT NOTIFICATION/RESOLUTION: Labeled B Lin Person Contacted&Datetrime: PM Review&Date: haac kl?man 6/27/25 NOTE: When there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEQ Certification Office. Qualtrax ID:52742 Effective Date:03/04/25 Page 1 of 1 Pace®Analytical Services,LLC(PAS) Page 10 of 11