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Page 21 of 21 <br /> WORK ORDER #: 10-08- FO 10 2EM <br /> !SAMPLECooler" 1, of <br /> CLIENT: Z �m AX DATE: 0815 / 10 <br /> TEMPERATURE: Thermometer ID: SC1 (Criteria: 0.0°C—6.0°C, not frozen) <br /> Temperature • °C + 0.5°C (CF) = 2 °C 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: <br /> CUSTODY SEALS INTACT: <br /> ❑ Cooler ❑ ❑ No (Not Intact). /NotPresent ❑ N/A Initial: <br /> ❑ Sample ❑ ❑ No (Not Intact) , Not Present Initial: <br /> SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody(COC) document(s) received with samples...................,0' ❑ ❑ <br /> COC document(s) received complete...................................................lp� ❑ ❑ <br /> ❑ Collection date/time,matrix, and/or#of containers logged in based on sample labels. <br /> ❑ No analysis requested. Cl Not relinquished. ❑ No date/time relinquished. <br /> Sampler's name indicated on COC.........:........................................... ❑ ❑ ❑ <br /> Sample container label(s) consistent with COC..................................... ❑ ❑ ❑ <br /> Sample container(s) intact and good condition...................................... .Fe' ❑ ❑ <br /> Proper containers and sufficient volume for analyses requested............... 40' ❑ ❑ <br /> Analyses received within holding time................................................. 4!� ❑ ❑ <br /> pH / Residual Chlorine/ Dissolved Sulfide received within 24 hours........... ❑ ❑ Kl' <br /> Proper preservation noted on COC or sample container........................... ❑ ❑ <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s)free of headspace........ ............................A� ❑ ❑ <br /> Tedlar bags)free of condensation...................................................... ❑ ❑ ,0 <br /> CONTAINER TYPE: <br /> Solid: 1]4ozCGJ 08ozCGJ ❑16ozCGJ ❑Sleeve ( ) ❑EnCoreso ❑TerraCorese ❑ <br /> Water: ❑VOA�;XOAh LJVOAna2 0125AGB ❑125AGBh ❑125AGBp 01AGB 01AGBna2 ❑1AGBs <br /> ❑500AGB 0500AGJ ❑500AGJs 0250AGB 13250CGB 13250CGBs 111PB ❑500PB ❑500PBna <br /> ❑250PB 0250PBn ❑125PB ❑125PBznna ❑100PJ ❑100PJna2 ❑ ❑ ❑ <br /> Air: ❑Tedlare ❑Summa® Other: ❑ Trip Blank Lot#: /mow Labeled/Checked by: <br /> Container: C:Clear A:Amber P:Plastic G:Glass J:Jar B:Bottle Z:ZiploGResealable Bag E. Envelope Reviewed by: <br /> Preservative: h:HCL n:HNO3 na2:Na2S203 na:NaOH p:H3PO4 s:H2SO4 znna:ZnAC2+NaOH f:Field-filtered Scanned by: <br /> SOP T100 090(05/10/10) <br />