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Page 25 of 25 <br /> WORK ORDER#: 09ml 010 ® I�1 <br /> to;r>�r <br /> ' • ' Cooler t of <br /> CLIENT: DATE: \0 <br /> TEMPERATURE: (Criteria: 0.0°C-8.00C,.not frozen) <br /> Temperature - c • 0 . -°C -0.2°C (CF) . = '--5 R7 °C . ❑ Blank FrIsample <br /> Ci Sample(s) outside temperature criteria.(PMIAPM 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: ❑Atr ❑ Filter ❑ Metals Only © PCBs Only Initial: <br /> i <br /> CUSTODY SEALS INTACT: <br /> ❑ Cooler ❑ 0 No(Not Intact) 0<0i Present ❑ NIA Initial: <br /> ❑ Sample El ❑ No(Not Intact) JdNot Present Initial: <br /> SAMPLE CONDITION: ..Yes No NIA <br /> Chaln-Of-Custody(COC)document(s) received with samples...................21/ Cl ❑ <br /> COC document(s) received complete............................................ ...... ❑ l� ❑ <br /> ElCollectlon dateitime,matrix,and/or#of containers logged In based on sample labels. <br /> 0 COC not relinquished. 0<date relinquished. Q`Noatime relinquished. <br /> Sampler's name indicated on COC..................................................... i ❑ ❑ <br /> Sample container label(s)consistent with COC..................................... lr d ❑ <br /> Sample containers intact and good condition........................... ❑ ❑ <br /> Correct containers and volume for analyses requested............................ 12� ❑ ❑ <br /> Analyses received within holding time................................................. W ❑ <br /> Proper preservation noted on COC or sample container...................:...... ❑ ❑ Rf <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis oontalner(s)free of headspace...................... <br /> Tedlar bag(s)free of condensation.........................................I............. ❑ ❑ <br /> CONTAINER TYPE: <br /> Solid: 1]4oZCGJ 08ozCGJ 0/16ozCGJ .❑Sleeve ❑EnCoreS® ❑TerraCorese ❑ <br /> Water: ❑VOA ❑VOAh ❑VOAnaa ❑125AGB E7126AGBh ❑125AGBp .❑1AGB ❑1AGBna2 111AGBs <br /> ❑500AGB 0600AGJ ❑500AGJs 0250AGB. 0260CGB EI250CGBs 01PB 13500PB 1:1500PBna <br /> 11250PB 0250PBn 11125PB 0125PBznna 0100PJ 0100PJna2 ❑ ❑ Cl <br /> Air: ©TedlarO ❑Summa® Other:. ❑ _ Trip Blank Lot#: Checked by: b' <br /> container: C:Geer A:Amber P:Plastlo G:Glass J:Jar S:Bottle Zr7lpladResealable Bag E:Envelop Reviewed by: is� <br /> Preservative: h:HCL n:HNO3 n4tr:Na23103 No.NaOH p:H3PO4'e:H2s04 xnna:ZnAc,2+NaOH f:Fleid•Ilkered Scanned by: <br /> ' Sfl G90 <br />