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Page 21 of 21 . <br /> r WORK ORDER #: 0 91-El F91=2 In 21 <br /> Cooler t of k <br /> fayte9l, JIM <br /> SAMPLE RECEIPT FORM <br /> CLIENT: +�- ���- DATE: VO-2A-139 <br /> TEMPERATURE: (Criteria:o.o°C-6.o°C) <br /> Temperature _AA L °C+ 1.8°C(CF) � �. °I °C Blank ❑ Sample PJ' <br /> Samples outside temperature criteria but received on icelchilied on same day of sampling ❑ <br /> Received at ambient temperature,placed on ice for transport by Courier ❑ <br /> Ambient Temperature(For Air& Filter Only) ❑ Initial:UPS, <br /> CUSTODY SEALS INTACT: <br /> ❑ Sample ❑ Cooler ❑ No(Not intact) 94NOOt Present Initial:, <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chain-Of-Custody document(s)received with samples................. 2" ❑ ❑ <br /> Samptees name indicated on COC........................................... W/ ❑ ❑ <br /> Sample container label(s)consistent with COC........................... U" ❑ ❑ <br /> Sample container(s)Intact and good condition............................ er ❑ ❑ <br /> Correct containers and volume for analyses requested................, RK ❑ ❑ <br /> Proper preservation noted on sample label(s)............................. ❑ ❑ 0.11 <br /> Volatile analysis container(s)free of headspace.......................... ❑ ❑ 0- <br /> Tedler beg(s)free of condensation.......................................... ❑ ❑ <br /> CONTAINER TYPE: <br /> Soli: 04ozCGJ ❑8ozCGJ 91'6*ozCGJ ❑sleeve ❑EnCores@ ❑TerraCores® ❑ <br /> Water: ❑VOA ❑VOAh ❑VOAna2 ❑125AGS ❑125AGBh ❑125AGBpoa ❑1 AGB ❑1AGBna2 <br /> 131AGBs ❑500AG13 ❑500AGBs 0260CGB 11250CGBs 131PB 0600PB 11600PBna 025OPS <br /> 13250PBn 0125PB 13126PBznne 13100PBstedle 13100PSna2 ❑ ❑ <br /> Air: ❑Tedlar@ ❑Swmma® ❑ <br /> Checked/Labeled by: <br /> CarsWn2r: c:Gear a;Amber P:PoiylPiasle 6:61ass s:Jar s:eotile Reviewed by: se ' <br /> Preservative: h:HCl. n:HNO, ne::Naj%03 na:Na0H W.H3PO4 SNA04, una:znAel4m m Scanned by: eS <br /> SOP T1o0 oso pom=a) <br />