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Page 21 of 21 <br /> r►es WORK ORDER #: O9-12'© © © 0 <br /> ^�' . • ' Cooler k of <br /> CLIENT: DATE: 1212- 109 <br /> TEMPERATURE: (Criteria: 0.0°C—6.0OC,not frozen) <br /> Temperature • 6 `C -0.8 OC (CF) °C Blank 0 Sample <br /> ❑ Sample(s)outside temperature criteria(PM/APM contacted by: ) <br /> ❑ Sampie(s)outside temperature criteria but received on ice/chilled on same day of sampling. <br /> ❑ Received at ambient temperature, placed on ice for transport by Courier. <br /> Ambient Temperature: ❑ Air ❑ Fitter ❑ Metals Only ❑ PCBs Only Initial: <br /> TTODY SEALS INTACT: <br /> oler El ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: <br /> ❑ Sample ❑ ❑ No(Not Intact) [a'14ot Present Initial: <br /> SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody(COC)document(s) received with samples................... Z ❑ ❑ <br /> COC document(s) received complete........................... ....................... <zJ ❑ ❑ <br /> ❑Collection dateliime,matrix,and/or#of containers logged In based on sample labels. <br /> ❑ COC not relinquished. ❑ No date relinquished. ❑ No time relinquished. / <br /> Sampler's name indicated on COC...........................•..................I...... ❑ ❑ ❑/ <br /> Sample container label(s) consistent with COC............ ....................... �// ❑ ❑ <br /> Sample container(s) intact and good condition...................................... 0 ❑ <br /> Correct containers and volume for analyses requested........................... ❑ ❑ <br /> Analyses received within holding time................. ............................... ❑ ❑ / <br /> Proper preservation noted on COC or sample container.......................... ❑ ❑ p� <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s)free of headspace..................................... ❑ ❑ <br /> Tedlar bag(s)free of condensation...................................................... ❑ ❑ <br /> CONTAIN R TYPE: <br /> Solid: 4ozCGJ 08ozCGJ C316ozCGJ ❑Sleeve ❑EnCores® ❑TerraCores® ❑ <br /> Water: OVOA ❑VOAh ❑VOAnai ❑125AGB 11125AGBh ❑125AGBp 01AGB ❑1AG8na2 ❑1AGBs <br /> 0500AGB 0500AGJ 0500AGJs 0250AGB 0250CGB 0250CGBs ❑1PB 0500PB ❑500PBna <br /> 0250PB 0250PBn 13125PB 11125PBznna ❑100PJ 0100PJna2 ❑ ❑ ❑ <br /> Air: ❑Tedlale ❑Summa® Other: ❑ Trip Blank Lot#: Checked by: Wl/ <br /> Contairter. C:peer A Fent»r G:Plastic 6:Glass J:Jar a:Bottle Z:ZiploNReseelaWe Beg E:Envelop Reviewed by: <br /> 1- <br /> P..rveaw: h:HCL n:HNO3 n%:NeiS*Ot Me:Na0H p:HJ10. s:HySO. mm ZnAcz-NaOH t Flel&flltered Scanned by: <br /> tm_ 61De) <br />