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Page 9(ooff 9 <br /> WORK ORDER #: O9-1 2-® ® ® LJ <br /> 1nIG ' - - Cooler k of t <br /> CLIENT: SQA DATE: 12100109 <br /> TEMPERATURE: (criteria: e.eeC—S.0DC, not frozen) � <br /> Temperature `J .�OC - 0.80C(CF) = e-&> °C 1-1IQ Blank 6/ample <br /> ❑ Sample(s)outside temperature criteria(PM/APM 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: ❑ Air ❑ Filter ❑ Metals Only ❑ PCBs Only Initial: <br /> CUSTODY SEALS INTACT: <br /> Cl-Cooler ❑ ❑ No (Not Intact) m�ot Present ❑ N/A Initial: <br /> ❑ Sample El No(Not Intact) Not Present Initial: 7 <br /> SAMPLE CONDITION: Yes No NIA <br /> Chain-Of-Custody(COC)documents)received with samples................... ❑ ❑ <br /> COC document(s)received complete.................................................. c e ❑ <br /> $Collection date/time,matrix,and/or#of containers logged in based on sample labels. <br /> ❑No analysis requested. ❑Not relinquished. ❑No datehime relinquished. <br /> Sampler's name Indicated on COC........................... .: . zr�/ ❑ ❑ <br /> Sample container labels)consistent with COC.............1....................... r2f/ ❑ ❑ <br /> Sample container(s)intact and good condition...................................... Q/ ❑ ❑ <br /> Correct containers and volume for analyses requested........................... Q ❑ ❑ <br /> Analyses received within holding time................................................. ❑ Cl <br /> Proper preservation noted on COC or sample container.......................... ❑ ❑ ff� <br /> ❑Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s)free of headspace..................................... ❑ ❑ <br /> Tedlar bag(s)free of condensatlon...................................................... ❑ O <br /> CONTAINER TYPE: <br /> Solid: 4ozCGJ ❑BOZCGJ 016ozCGJ ❑Sleeve ❑EnCorese ❑TerraCores® ❑ <br /> Water: ❑VOA ❑VOAh ❑VOAna2 0125AGB 0125AG5h 0125AGBp ❑1AGB 01AGBna2 01AGBs <br /> 0500AGB 11500AGJ 0500AGJs 0250AGB 0250CGB 0250CGBs 01PB 0500PB ❑500PBna <br /> 025OPS 0250PBn 0125PB 0125PBznna 0100PJ 0100PJna2 ❑ ❑ ❑ <br /> Air: ❑Tedlar® ❑Summa® Other: ❑ Trip Blank Lot#: Checked by: 1-)f(l) 1 <br /> container. C:Clear A:Amber P:Plastic e:Gau J:Jar B:Bottle Z:zlplo Resealable Bag E:Envelop Reviewed by: ✓V ( <br /> Preservative: h:HG. n:HNO3 rW:NerSA No:NaOH p:H3PO. e:HW4 Z n :ZMcr«NeOH f:Fleldfilleed Scanned by:—U92— <br /> rao_o-(oetero� <br />