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Page 22 of 22 WORK ORDER #: 1 -09-©�3 ]I O ' Cooler / of CLIENT: 3 DATE: 09 /X TEMPERATURE: Thermometer ID: SCI (Criteria: 0.0 °C – 6.0 °C, not frozen) Temperature _ f . 6 °C + 0.5 °C (CF) = _.2,• f °C ErBlank ❑ 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. YL' Ambient Temperature: ❑ Air ❑ Filter Initial: I CUSTODY SEALS INTACT: �/ 0� Cooler ❑ C1 No (Not Intact) ❑ Not Present ❑ N/A Initial: L �-- ❑ Sample ❑ ❑ No (Not Intact) PINot Present Initial: —I— SAMPLE CONDITION: Yes No N/A Chain -Of -Custody (COC) document(s) received with samples ................... t3 ❑ ❑ COC document(s) received complete ................................................... ❑ ❑ ❑ 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 ...................................................... i�/ ❑ ❑ Sample container label(s) consistent with COC ...................................... Uf ❑ ❑ Sample container(s) intact and good condition ....................................... Rr ❑ ❑ Proper containers and sufficient volume for analyses requested ................ l/ ❑ ❑ Analyses received within holding time .................................................. 12( ❑ ❑ pH / Res. Chlorine / Diss. Sulfide / Diss. Oxygen received within 24 hours... ❑ ❑ e Proper preservation noted on COC or sample container .......................... ❑ ❑ ❑ Unpreserved vials received for Volatiles analysis Volatile analysis container(s) free of headspace..................................... ❑ ❑ Pl Tedlar bag(s) free of condensation...................................................... ❑ ❑ CONTAINER TYPE: Solid: 04ozCGJ 08ozCGJ 016ozCGJ ZSleeve (–S ) ❑EnCores® ❑TerraCoreO ❑ Water: ❑VOA ❑VOAh 0VOAna2 0125AGB 0125AGSh ❑125AGBp 01AGB 01AGBna2 ❑1AGBs 0500AGB 1:1500AGJ 0500AGJs 0250AGB 0250CGB 0250CGBs 01PB 0500PB 0500PBna 0250PB 0250PBn 11125PB 0125PBznna 0100PJ 0100PJna2 ❑ ❑ ❑ Air: ❑Tedlar® ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by: Container: C: Clear A: Amber P: Plastic G: Glass J: Jar B: Bottle z: ZiploclResealable Bag E: Envelope Reviewed by: Sv Preservative: h: HCL n: HNO3 na2:Na2S203 na: NaOH p: H3PO4 s: HzSD, tnna: ZnAc2+NaOH f: Field -filtered Scanned by: 50PT100_Mj03rM11)