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9tnrl�r� oborvtadaay -Inc. C.A&MO ` Z4 Page 15 of 16 WORK ORDER #: i i -09-© a Cooler I of DATE: 09 /Z3 /I 1 TEMPERATURE: Thermometer ID: SCI (Criteria: 0.0 °C — 6.0 °C, not frozen) Temperature OC + 0.5 °C (CF) _ °C Blank El Sample ❑ Sample(s) outside temperature criteria (PM/APM contacted by: ). ❑ Sample(s) outside temperature criteria but received on ice/chilled on same day of sampling. ❑ Received at ambient temperature, placed on ice for transport by Courier. Ambient Temperature: ❑ Air ❑ Filter Initial: CUSTODY SEALS INTACT: 21 ooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: ❑ Sample ❑ ❑ No (Not Intact) 2 Not Present Initial: SAMPLE CONDITION: Yes No N/A Chain -Of -Custody (COC) document(s) received with samples .................. Z' ❑ ❑ COC document(s) received complete...................................................1' ❑ ❑ ❑ Collection date/time, matrix, and/or # of containers logged in based on sample labels. ❑ No analysis requested. ❑ Not relinquished. ❑ No date/time relinquished. Sampler's name indicated on COC......................................................)2' ❑ ❑ Sample container label(s) consistent with COC ...................................... Z' ❑ ❑ Sample container(s) intact and good condition.......................................0' ❑ ❑ Proper containers and sufficient volume for analyses requested ................ a ❑ ❑ Analyses received within holding time ...................................................' ❑ ❑ pH / Res. Chlorine / Diss. Sulfide / Diss. Oxygen received within 24 hours... ❑ ❑ j2r Proper preservation noted on COC or sample container .......................... Q-1 ❑ ❑ ❑ Unpreserved vials received for Volatiles analysis Volatile analysis container(s) free of headspace..................................... ❑ ,8' ❑ Tedlar bag(s) free of condensation...................................................... ❑ ❑ CONTAINER TYPE: Solid: 04ozCGJ 08ozCGJ 016ozCGJ ❑Sleeve ( ❑EnCoreso ❑TerraCorese ❑ Water: OVOA,bAh ❑VOAna2 0125AGB 0125AGBh 0125AGBp 131AGB 01AGBna2 0.1AGBs 0500AGB,45 0AGJ 0500AGJs ❑250AGB 0250CGB 0250CGBs 01PB 0500PB 0500PBna 0250PB 0250PBn 11125PB 0125PBznna ❑100PJ 0100PJna2 ❑ ❑ ❑ Air: ❑Tedlare ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by: 4a _ Container. C: Clear A: Amber P: Plastic G: Glass J: Jar B: Bottle Z: Ziploc/Resealable Bag E: Envelope Reviewed by: Preservative: h: HCL n: HNO3 na2:Na2S203 na: NaOH p: H3PO4 s: H2SO4 znna: ZnAc2+NaOH f: Field -filtered Scanned by: SOP T100 090 (0=4H1)