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Pane 18 of 18 <br /> WORK ORDER #: 09-0 5-R] KI 121 <br /> Cooler I of <br /> CLIENT: Sh-e I DATE: 05 <br /> TEMPERATURE: (Criteria: Q.0°C-6-OOC, not frozen) <br /> Temperature S _• 9 °C - 0.2 OC (CF) = S _•. .00 O Blank 2'1§�mple <br /> ❑ Sample(s)outside temperature crlterla(PMIAPM contacted by: ). <br /> ❑ Sample(s)outside temperature criteria but received on Icelchilled on sage day of sampling. <br /> ❑ Received at ambient temperature, placed on ice for transport by Courier. <br /> Ambient Temperature: ❑Air ❑ Filter ❑ Metals Only ❑ PCBs Only Initial: <br /> CUSTODY SEALS INTACT: <br /> ❑ Cooler ❑ ❑ No (Not Intact) RI'Not Present ❑ NIA Initial: <br /> ❑ Sample ❑ ❑ No (Not Intact) [ Not Present Initial: � .- <br /> SAMPLE CONDITION: Yes No NIA <br /> Chain-Of-Custody(COC)document(s)received with samples................... ❑ ❑ <br /> COC document(s) received complete................................................... P", ❑ <br /> ❑Collection dateltlme,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..................................................... [� ❑ ❑ <br /> Sample container label(s) consistent with COC..................................... ff, ❑ ❑ <br /> Sample container(s) intact and good condition...................................... lid ❑ ❑ <br /> Correct containers and volume for analyses requested........................... W", ❑ ❑ <br /> Analyses received within holding time................................................. e ❑ ❑ <br /> Proper preservation noted on COC or sample container.......................... ❑ ❑ p- <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis contalner(s)free of headspace..................................... ❑ ❑ ?r <br /> Tedlar bag(s)free of condensation...................................................... ❑ ❑ <br /> CONTAINER TYPE: <br /> Solid: 04ozCGJ 08ozCGJ 016ozCGJ ❑Sleeve ❑EnCores® ❑TerraCoreeP 0--l-_ <br /> Water: ❑VOA ❑VOAh 0V0Ana2 0125AGB 0125AG13h 0125AGBp 01AG13 01AGBnax 01AG13s <br /> 1:3500AGB 0500AGJ 0500AGJs 0250AGB 0250CGB 0250CGBs E31PB 0500PB 0500PBna <br /> 13260PB 0250PBn 0125PB 0125PBznna 0100PB ❑100PBna2 ❑ ❑ ❑ <br /> Air. ❑Tedlar® ❑SummO ❑ Other: ❑ Checked/Labeled by: <br /> Container: C:Clear A:Amber P.Plastio 0:Glass J.,lar(WIde-mouth) 8:Bottle(Narrow-mouth) Reviewed by: <br /> Preservative: h:HCL n:HNO3 na2:Na2S203 Na:Ne0H p:HzPo. a:HZSO4 znna:zr►Ac2+NaOH f:Fteld-tiltared scanned by: <br /> SOP T100_090(03113109) <br />