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- WORK ORDER #: 09-04- LJEN Cooler of CLIENT: �� DATE: TEMPERATURE: (Criteria: 0.0°C-6.0°C, not frozen) Temperature 2 . (6 OC - 0.20C (CF) = Z .10 °C Blank ❑ Sample ❑ Sample(s)outside temperature criteria (PM/APM contacted by: ). ❑ Sample(s) outside temperature criteria but received on ice/chilled on same day of sampling. ❑ Received at ambient temperature, placed on ice for transport by Courier. Ambient Temperature: ❑ Air ❑ Filter ❑ Metals Only ❑ PCBs Only Initial: .5 e— CUSTODY SEALS INTACT: ❑ Cooler ❑ ❑ No (Not Intact) /Not Present ❑ N/A Initial_ El Sample El El No (Not Intact) Not Present Initial: SAMPLE CONDITION: Yes No N/A Chain-Of-Custody (COC) document(s) received with samples................... ❑ ❑ COC document(s) received complete................................................... E� ❑ ❑ ❑ Collection date/time, matrix, and/or#of containers logged in based on sample labels. ❑ COC not relinquished. ❑ No date relinquished. ❑ No time relinquished. Sampler's name indicated on COC..................................................... ❑ ❑ Sample container label(s) consistent with COC..................................... ❑ ❑ Sample container(s) intact and good condition...................................... .d ❑ ❑ Correct containers and volume for analyses requested........................... 7� ❑ ❑ Analyses received within holding time................................................. Z ❑ ❑ Proper preservation noted on COC or sample container.......................... � ❑ ❑ ❑ Unpreserved vials received for Volatiles analysis / Volatile analysis container(s)free of headspace..................................... ❑ ❑ Tedlar bag(s)free of condensation...................................................... ❑ ❑ I� CONTAINER TYPE: Solid: 04ozCGJ 08ozCGJ ❑16ozCGJ ❑Sleeve ❑EnCorese ❑TerraCorese ❑ Water: ❑VOA`qVOAh 0VOAna2 11125AGB ❑125AGBh 0125AGBp 01AGB 2.11AGBna, ❑1AGBs ❑500AGB ,1�500AGJ ❑500AGJs 1:1250AGB 0250CGB 0250CGBs 01PB ❑500PB ❑500PBna ❑250PB 0250PBn ❑125PB ❑125PBznna ❑100PB ❑100PBna2 ❑ ❑ ❑ Air: ❑Tedlaro ❑Summa° ❑ Other: ❑ Checked/Labeled by: Container: C:Clear A:Amber P: Plastic G: Glass J:Jar(Wide-mouth) B:Bottle(Narrow-mouth) Reviewed by: Preservative: h:HCL n:HNO3 naZ:Na2S203 Na:NaOH p:H3PO4 s:H2SO4 znna:ZnAcz+NaOH f:Field-filtered Scanned by SOP T100_090(03/13/09)