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Page 52 of 54 <br /> cderrou <br /> rrvf arra �rtr�f WORK ORDER M 10-12- <br /> 0 <br /> L8�3ctYd1'A3V71�'&f �19G� <br /> 'yc�"" Cooler of <br /> - <br /> CLIENT: IVIG I`VI 1 P Cyl DATE: 12 /2`l/ 10 <br /> TEMPERATURE: Thermometer ID: SCI (Criteria: 0.0 eC—6.0°C, not frozen) <br /> Temperature 2 . G OC + 0.5°C (CF) =_ 3 1—°C lank ❑ 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 Initial: <br /> CUS DY SEALS INTACT: <br /> ioor'Cooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: <br /> ❑ Sample ❑ ❑ No (Not Intact) ZfNot Present Initial: <br /> SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody(COC)document(s) received with samples...................Rf' ❑ ❑ <br /> COC document(s) received complete....................................................8' ❑ o <br /> ❑ Collection date/time,matrix,and/or#of containers logged in based on sample labels. <br /> ❑ No analysis requested. ❑ Not relinquished. ❑ No date/time relinquished. <br /> Sampler's name indicated on COC..................................................... 11:!� ❑ ❑ <br /> Sample container label(s) consistent with COC..................................... ja ❑ ❑ <br /> Sample container(s) intact and good condition...................................... 0 ❑ ❑ <br /> Proper containers and sufficient volume for analyses requested............... 17 ❑ ❑ <br /> Analyses received within holding time................................................. C?" ❑ ❑ <br /> pH / Residual Chlorine/Dissolved Sulfide received within 24 hours........... ❑ ❑ 0� <br /> Proper preservation noted on COC or sample container..........................Zr ❑ 7- <br /> 11 <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s)free of headspace.....................................g ❑ ❑ <br /> Tedlar bag(s)free of condensation...................................................... ❑ ❑ g' <br /> CONTAINER TYPE: <br /> Solid: ❑4ozCGJ 08ozCGJ 016ozCGJ ❑Sleeve ( ) ❑EnCores's ❑TerraCoreso ❑ <br /> 3 <br /> Water: ❑VO�A�,Z'VOAh 0V0Ana2 ❑125AGB ❑125AGBh 0125AGBp ❑1AGB ❑1AGBna2 ❑1AGBs <br /> 0500AGB .�500AGJ ❑500AGJs 0250AGB 0250CGB 0250CGBs 01PB ❑500PB ❑500PBna <br /> ❑250PB 0250PBn 0125PB 0125PBznna 0100PJ 0100PJna2 ❑ ❑ ❑ <br /> Air: ❑Tedlaro ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by:A�� <br /> Container: C:Clear A:Amber P:Plastic G:Glass J:Jar B:Bottle Z:Ziploc/Resealable 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(09110110) <br />