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Page 37 of 37 <br /> Laboratoriois, Inc- WORK ORDER #: 11 -05-O ❑ <br /> SAMPLES - CONTAINERS & LABELS: Comments: i <br /> ❑ Sam ple(s)IContainer(s) NOT RECEIVED but listed on COC 6 i I a�,e IJ 0,S S a <br /> ❑ Sam ple(s)IContainer(s) received but NOT LISTED on COC dry Y t,-,,e <br /> ❑ Holding time expired— list sample 1D(s) and test <br /> ❑ Insufficient quantities for analysis — list test �T Z�� 0 .ew�- <br /> ❑ Improper container(s) used— list test I-L+0 <br /> ❑ Improper preservative used —list test <br /> ❑ No preservative noted on COC or label — list test & notify lab <br /> ❑ Sample labels illegible— note test/container type <br /> P/Sample label(s) do not match COC — Note in comments <br /> .O Sample ID <br /> kr Date and/or Time Collected <br /> ❑ Project Information <br /> ❑# of Container(s) <br /> ❑Analysis <br /> ❑Sample container(s) compromised — Note in comments <br /> ❑Water present in sample container <br /> ❑ Broken <br /> ❑ Sample container(s) not labeled <br /> ❑ Air sample container(s) compromised — Note in comments <br /> ❑ Flat <br /> ❑Very low in volume <br /> ❑ Leaking (Not transferred - duplicate bag submitted) <br /> ❑ Leaking (transferred into Calscience Tedlar° Bag*) <br /> ❑ Leaking (transferred into Client's Tedlar° Bag*) <br /> ❑ Other: <br /> HEADSPACE - Containers with Bubble > 6mm or 1/4 inch: <br /> Sample# Container #of Vials Sample# Container ID(s) #of Vials Sample# Container #of Cont. Analysis <br /> ID(s} Received Received LD(s) received <br /> Comments: <br /> *Transferred at Client's request. initial 1 Date: "IL.05 104/11 <br /> SOP T100_090(09117110) <br />