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Page 21 of 21 <br /> C�Iswv-nVle WORK ORDER #: E] ®- t❑ C7 -D ® 0 D <br /> Cooler t of t <br /> SAMPLE RECEIPT FORM <br /> CLIENT: �h'�` ���- DATE: V0 -2-\—'38r <br /> TEMPERATURE: (Criteria: 0.0°C-6.4°C) <br /> Temperature _ 4 . 1 °C + 1.8°C (CF) __ . °1 °C Blank ❑ Sample <br /> Samples outside temperature criteria but received on icelchilled 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: <br /> CUSTODY SEALS INTACT: <br /> ❑ Sample ❑ Cooler ❑ No (Not Intact) 13'Not Present Initial: <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chain-Of-Custody document(s) received with samples................. C� ❑ ❑ <br /> Sampler's name indicated on COC........................................... ❑ ❑ <br /> Sample container label(s)consistent with COC........................... Ey ❑ ❑ <br /> Sample container(s) intact and good condition............................ Qr ❑ ❑ <br /> Correct containers and volume for analyses requested................. Ey" ❑ ❑ <br /> Proper preservation noted on sample label(s)............................. ❑ ❑ CY <br /> Volatile analysis container(s)free of headspace.......................... ❑ ❑ <br /> Tedlar bag(s)free of condensation.......................................... ❑ ❑ 3� <br /> CONTAINER TYPE=: <br /> Soil: ❑4ozCGJ ❑8ozCGJ 91'6ozCGJ ❑Sleeve ❑EnCores® ❑TerraCoresO ❑ <br /> Water: ❑VOA ❑VOAh ❑VOAna2 ❑125AGB ❑125AGBh 0125AGBp04 ❑1AGB ❑1AGBna2 <br /> ❑1AGBs 0500AGS 0500AGBs ❑250CGB ❑250CGBs ❑1 PB 0500P6 ❑500PBna ❑250PB <br /> ❑250PBn ❑125PB ❑125PBznna ❑100PBsterile ❑100PBna2 ❑ ❑ <br /> Air: ❑Tediar0 ❑SummaO ❑ <br /> Checked/Labeled by: � <br /> Container: C:Clear A:Amber P_PoSy/Plastic G:Glass J:Jar B:Bottle Reviewed by-. <br /> Preservative: h:HCL n:HN% na2:NazS203 na:NaOH PO4:H3PO4 s:HZSO, znna:ZnAcz+NaOH Scanned by: r'1 <br /> SOP T100_090(1Oil 3108) <br />