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vrta� " <br />CLIENT: 16 OR -T <br />Page 16 of 16 <br />WORK ORDER #: 11 _09_ 1Z1 M ❑v ❑o <br />Cooler / of <br />DATE: 09 A4 /I I <br />TEMPERATURE: Thermometer ID: SCI (Criteria: 0.0 °C — 6.0 °C, not frozen_..),,� <br />Temperature �_- 6 °C + 0.5 °C (CF) = �- . fOC EMilank ❑ Sample <br />❑ Sample(s) outside temperature criteria (PM/APM contacted by: ). <br />❑ Sample(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 ❑ Filter Initial: <br />CUSTODY SEALS INTACT: Y(-- <br />I60oler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: <br />❑ Sample ❑ ❑ No (Not Intact) PrINO'ot Present Initial: <br />SAMPLE CONDITION: Yes <br />No <br />Chain -Of -Custody (COC) document(s) received -with samples ................... <br />Z <br />❑ <br />COC document(s) received complete ................................................... <br />❑ <br />❑ Collection date/time, matrix, and/or # of containers logged in based on sample labels. <br />❑ No analysis requested. ❑ Not relinquished. ❑ No date/time relinquished. <br />Sampler's name indicated on COC ...................................................... <br />jzf <br />❑ <br />Sample container label(s) consistent with COC ....................................... <br />2( <br />❑ <br />Sample container(s) intact and good condition ....................................... <br />I( <br />❑ <br />Proper containers and sufficient volume for analyses requested ................ <br />❑ <br />Analyses received within holding time .................................................. <br />f <br />❑ <br />pH / Res. Chlorine / Diss. Sulfide / Diss. Oxygen received within 24 hours... <br />❑ <br />❑ <br />Proper preservation noted on COC or sample container .......................... <br />0100 <br />❑ <br />❑ Unpreserved vials received for Volatiles analysis <br />Volatile analysis container(s) free of headspace..................................... <br />❑ <br />Tedlar bag(s) free of condensation...................................................... <br />❑ <br />❑ <br />CONTAINER TYPE: <br />N/A <br />C <br />11 <br />Solid: 040ZCGJ Qgqz= 016ozCGJ ❑Sleeve (❑EnCores® ❑TerraCoreso ❑ <br />Water: ❑VOA ❑VOAnaz 11125AGB 11125AGBh 0125AGBp 01AGB 01AGBna2 01AGBs <br />0500AGB d500 GJ 0500AGJ9 0250AGB 0250CGB 0250CG139 01PB 0500PB 0500PBna <br />13250PB 0250PBn 0125PB 0125PBznna 0100PJ 0100PJna2 ❑ ❑ ❑ <br />Air: ❑Tedlar® ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Chocked by: VC <br />Container. C: Clear A. Amber P: Plastic G: Glass J: Jar B: Bottle Z: Ziploc/Ressalable Bag E: Envelope Reviewed by: <br />Preservative: h: HCL n: HNO3 na2:Na2S203 na: NaOH p: H3PO4 s: H2SO4 znna: ZnAc2;NaOH h Field -filtered Scanned by: WfrI <br />90P T700-090 (03/24/11) <br />