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Page 48 of 48 ti®:�- e U rof I n s WORK ORDER NUMBER: 1 5-05— I Calscience SAMPLE RECEIPT CHECKLIST BOX__/ OF CLIENT: DATE: 051 12015 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 (wl CF): Z3,-,o 'C; ❑ Blank XSample ample(s)outside temperature criteria (PMIAPM contacted by: ) ❑ Sample(s) outside temperature criteria but received on icelchilled on same day of sampling ❑ Sample(s) received at ambient temperature; placed on ice for transport by courier Ambient Temperature: ❑ Air ❑ Filter Checked by: OIL— CUSTODY SEAL: Box ❑ Present and Intact ❑ Present but Not Intact 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................................................... Ply ❑ ❑ COG documents) received complete ................................................................................. ❑ !;}' ❑ ❑ Sampling date ❑ Sampling time Matrix ❑ Number of containers ❑ No analysis requested ❑ Not reli quished 7 No relinquished date No relinquished time Sampler's name indicated on COC ................................................................ ................... ❑ J ❑ Sample container label(s) consistent with COC ..................................................................... p� 13 ❑ Sample container(s) intact and in good condition .................................................................. /� ❑ ❑ Proper containers for analyses requested ........................................................................... ,l J ❑ ❑ Sufficient volume/mass for analyses requested ..................................................................... ❑ ❑ Samples received within holding time ................................................................................. m ❑ ❑ 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.................................... ❑ ❑ ❑^ 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 0 VOAna2 ❑ 100PJ ❑ 100PJna2 ❑ 125AGB ❑ 125AGBh ❑ 125AGBp ❑ 125PB ❑ 125PBznna ❑ 250AGB ❑ 250CGB ❑ 250CGBs ❑ 250PB ❑ 250PBn ❑ 500AGB 0 500AGJ ❑ 500AGJs 500PB ❑ 1AGB ❑ 1AGBna2 ❑ 1AGBs © 1PB ❑ 1PBna ❑ ❑ ❑ ❑ Solid: ❑ 4ozCGJ ❑ 8ozCGJ16ozCGJ ❑ Sleeve ( ) ❑ EnCoresa 4 - ) ❑TerraCoreso(^�) ❑ Air: ❑TedlarT"" ❑ Canister Sorbent Tube O PUF ❑ Other Matrix( ): ❑ ID Container:A=Amber, B= Bottle, C=Clear, E = Envelope,G= Glass, J =Jar, P= Plastic, and Z=Ziploc/Resealable Bag Preservative: b= buffered,f=filtered, h= HC1, n = HNO3, na= NaOH, nae=Na2S201 P= H3PO4, Labeled/Checked by: o" s= H2SO4, u=ultra-pure,znna =Zn(CH3CO2)2+ NaOH Reviewed by: 2015-04-10 Revision