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Page 48 of 48 tiff e U rof l n S WORK ORDER NUMBER: 15-05- I Calscienice SAMPLE RECEIPT CHECKLIST BOX__/ OF / CLIENT: % =r DATE: 05 2015 TEMPERATURE: (Criteria: 0.0°C-6.0°C, not frozen except sediment/tissue) Thermometer ID: SC2 (CF:-0.3°C); Temperature (w/o CF):- °C (wI CF): 0,6 °C; ❑ Blank &Sample ample(s)outside temperature criteria (PMIAPM contacted by: ) ❑ Sample(s) outside temperature criteria but received on ice/chilled on same day of sampling ❑ Sample(s) received at ambient temperature; placed on ice for transport by courier Ambient Temperature: ❑ Air ❑ Filter Checked by: CUSTODY SEAL: �, y Box ❑ Present and Intact ❑ Present but Not Intact 6 Not Present ❑ NIA Checked by: " Sample(s) ❑ Present and Intact ❑ Present but Not Intact Not Present ❑ NIA Checked by: SAMPLE CONDITION: Yes No NIA Chain-of-Custody(COC)document(s) received with samples................................................... 0, ❑ ❑ COC document(s) received complete ................................................................................. ❑ I ❑ ❑ Sampling date ❑ Sampling time atrix ❑ Number of containers / • No analysis requested ❑ Not reli quished 7 No relinquished date ,vf No relinquished time Sampler's name indicated on COC ................................................ ............. ................... p ❑ Sample container label(s) consistent with GOC ..................................................................... ❑ ❑ Sample container(s) intact and in good condition .................................................................. /'J ❑ ❑ Proper containers for analyses requested ........................................................................... ❑ ❑ Sufficient volume/mass for analyses requested ..................................................................... ❑ ❑ Samples received within holding time ................................................................................. j� ❑ ❑ Aqueous samples for certain analyses received within 15-minute holding time / pH ❑ Residual Chlorine ❑ Dissolved Sulfide ❑ Dissolved Oxygen ❑ ❑ Proper preservation chemical(s) noted on COC and/or sample container.................................... ❑ ❑ p� Unpreserved aqueous sample(s)received for certain analyses ❑ Volatile Organics ❑ Total Metals ❑ Dissolved Metals Container(s) for certain analysis free of headspace ............................................................... ❑ ❑ ❑ Volatile Organics ❑ Dissolved Gases (RSK-175) ❑ Dissolved Oxygen (SM 4500) ❑ Carbon Dioxide (SM 4500) ❑ Ferrous iron (SM 3500) ❑ Hydrogen Sulfide (Hach) TedlarTm bag(s)free of condensation ................................................................................. ❑ ❑ CONTAINER TYPE: (Trip Blank Lot Number: ) Aqueous: ❑VOA ❑ VOAh ❑VOAna2 ❑ 100PJ ❑ 100PJna2 ❑ 125AGB ❑ 125AGBh ❑ 125AGBp ❑ 125PB ❑ 125PBznna ❑ 250AGB ❑ 250CGB ❑ 250CGBs ❑ 250PB ❑ 250PBn ❑ 500AGB ❑ 500AGJ ❑ 500AGJs ❑ 500PB ❑ 1AGB ❑ 1AGBna2 ❑ 1AGBs ❑ 1PB ❑ 1PBna ❑ ❑ ❑ ❑ Solid: ❑ 4ozCGJ ❑ 8ozCGJ16ozCGJ ❑ Sleeve ( ) ❑ EnCoresa( ) ❑TerraCores'�(�) ❑ Air: ❑ TedlarTI ❑ Canister Sorbent Tube ❑ PUF ❑ Other Matrix( ): ❑ ❑ Container:A=Amber, B= Bottle, C=Clear, E= Envelope,G=Glass, J =Jar, P= Plastic, and Z=ZiplocJResealable Bag Preservative: b= buffered,f=filtered, In= HCI, n = HNO3, na= NaOH, nae= Na2S203, p= H3PO4, Labeled/Checked by: s= H2SO4, u=ultra-pure,znna=Zn(CH3CO2)2+ NaOH Reviewed by: 2015-04-10 Revision