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Page 26 of 26 - <br /> WORK ORDER #: E F& 0 EJ 0,0 37 E <br /> ,QV- ; Cooker I of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: , I`�aJ15C9 n DATE: _ O 23�p <br /> TEMPERATURE: - <br /> Temperature 3 °C + 1.8°C (CF) _ _ '"t °C Blank L? Sample ❑ <br /> Samples 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 (For Air & Filter Only) ❑ Initial: <br /> CUSTODY SEALS INTACT: <br /> El' Sample ❑ Cooler ❑ No (Not Intact) R Not Present Initial: <br /> SAMPLE CONDITION: <br /> Yes No N/A <br /> Chain-Of-Custody document(s) received with samples................. ❑ ❑ <br /> Sampler's name indicated on COC........................................... ❑ ❑ <br /> Sample container label(s) consistent with COC........................... ❑ ❑ <br /> Sample container(s) intact and good condition............................ ❑ ❑ <br /> Correct containers and volume for analyses requested................. 'Ile ❑ ❑ <br /> Proper preservation noted on sample label(s)............................. ❑ ❑ /LJ <br /> Volatile analysis container(s) free of headspace.......................... ❑ ❑ <br /> Tedlar bag(s)free of condensation.......................................... ❑ ❑ <br /> If you marked"NO" for any of the items complete a Sample Receipt Anomaly form. <br /> CONTAINER TYPE: <br /> Soil: ❑4ozCGJ/�]8ozCGJ ❑16ozCGJ ❑Sleeve ❑EnCcreSO ❑TerraCoresO ❑ <br /> Water: ❑VOA ❑VOAh ❑VOAna2 ❑125AGB ❑125AGBh ❑125AGBpo4 ❑1 AGB ❑1 AGBna2 <br /> ❑lAGBs ❑500AGB ❑500AGBs ❑250CGB ❑250CGBs 1:11PB 0500PB ❑'500PBna ❑250PB <br /> ❑250PBn ❑125PB ❑125PBznna ❑100PBsterile ❑100PBna2 ❑ ❑ <br /> Air: ❑Tedlar:R) ❑Summa® ❑ <br /> Checked)/'Labeled by: 4-P - <br /> Container: C:Clear A:Amber P:Poly/Plastic G:Glass J:Jar B:Bottle Reviewed by. /jLkl? C, <br /> Preservative: h:HCL n:HNO, na,:N21S20, na:NaOH po,:HaPOa s:H2SO, znna:ZnAC2+NaOH Scanned by: A, <br /> SOP T100_090(10/13/08) <br /> I <br />