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- WORK ORDER #: 09-04-ETM MAM <br /> 7.......... <br /> -e :t MINAS= Cooler of <br /> CLIENT: per, cC-nS DATE: 0,q10 <br /> TEMPERATURE: (Criteria: 0.0°C-6.0°C, not frozen) <br /> Temperature 2 . (o °C - 0.2°C (CF) =� 4 °C 2 Blank ❑ Sample <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: Nt✓ <br /> CUSTODY SEALS INTACT: <br /> ❑ Cooler ❑ ❑ No (Not Intact) ot Present ❑ N/A Initial: i <br /> ❑ Sample ❑ ❑ No (Not Intact) ,eS Not Present Initial: _YL, <br /> SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody (COC) document(s) received with samples................... )Z3 ❑ ❑ <br /> COC document(s) received complete................................................... P ❑ ❑ <br /> ❑ Collection date/time, matrix, and/or#of containers logged in based on sample labels. <br /> ❑ COC not relinquished. ❑ No date relinquished. ❑ No time relinquished. <br /> Sampler's name indicated on COC..................................................... � E] El <br /> Sample container label(s) consistent with COC..................................... Pf ❑ ❑ <br /> Sample container(s) intact and good condition...................................... F1 ❑ ❑ <br /> Correct containers and volume for analyses requested........................... /vT ❑ ❑ <br /> Analyses received within holding time................................................. F ❑ ❑ <br /> Proper preservation noted on COC or sample container.......................... P, ❑ ❑ <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s)free of headspace.....................................F, ❑ ❑ <br /> Tedlar bag(s)free of condensation...................................................... ❑ ❑ <br /> CONTAINER TYPE: <br /> Solid: ❑4ozCGJ C 8ozCGJ 016ozCGJ ❑Sleeve ❑EnCorese ❑TerraCoreso ❑ <br /> Water: ❑VOA PfVOAh ❑VOAna2 ❑125AGB ❑125AGBh ❑125AGBp /Z 1AGB ❑1AGBna2 ❑1AGBs <br /> ❑500AGB 0500AGJ ❑500AGJs ❑250AGB 0250CGB ❑250CGBs ❑1PB 0500PB ❑500PBna <br /> ❑250PB 0250PBn ❑125PB ❑125PBznna ❑100PBsterile 0100PBna2 ❑ ❑ ❑ <br /> Air: ❑Tedlaro ❑Summa° ❑ Sludge/Other: ❑ Checked/Labeled by: , L <br /> Container: C:Clear A:Amber P:Plastic G:Glass J:Jar(Wide-mouth) B:Bottle(Narrow-mouth) Reviewed by: <br /> Preservative: h:HCL n:HNO3 na2:Na2S2% Na:NaOH p: H3P0, s:H2S0, znna:ZnAc2+NaOH Scanned by: 1 <br /> SOP T100_090(03/13/09) <br />