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Affilift Page 72 of 73 <br /> WORK ORDER #: 1'0-09-[D F71 © Q <br /> ` - Cooler ,�- of -5- <br /> CLIENT: <br /> CLIENT: fJ Z'S DATE: 09102110 <br /> TEMPERATURE: Thermometer ID: SCI (Criteria: 0.0 OC —6.0 QC, not frozen) <br /> Temperature 2 e 0 °C + 0.5 OC (CF) = 2— a -5— OC eBlank ❑ 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 Cl Filter ❑ Metals Only ❑ PCBs Only Initial: d �' <br /> CUSTODY SEALS INTACT: <br /> ❑ Cooler ❑ ❑ No (Not Intact) ;21'N of Present ❑ N/A Initial: <br /> ❑ Sample ❑ ❑ No (Not Intact) ZNot Present Initial: <br /> SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody (COC) document(s) received with samples................... j, ❑ ❑ <br /> COC document(s) received complete................................................... �r ❑ ❑ <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..................................................... ❑ ❑ <br /> Sample container label(s) consistent with COC..................................... p ❑ <br /> Sample container(s) intact and good condition...................................... ❑ ❑ <br /> Proper containers and sufficient volume for analyses requested............... [Z( ❑ ❑ <br /> Analyses received within holding time................................................. ❑ ❑ <br /> pH / Residual Chlorine/ Dissolved Sulfide received within 24 hours........... ❑ ❑ Ell' <br /> Proper preservation noted on COC or sample container.......................... Z' ❑ ❑ <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s) free of headspace..................................... ❑ ❑ <br /> Tedlar bag(s) free of condensation...................................................... ❑ ❑ <br /> CONTAINER TYPE: <br /> Solid: ❑4ozCGJ 08ozCGJ 1116ozCGJ ❑Sleeve ( ) ❑EnCoreso ❑TerraCorese ❑ <br /> y <br /> Water: ❑VOA ❑VOAh 0VOAna2 ❑125AGB 11125AGBh 0125AGBp ,e(1AGB ❑1AGBna2 ❑1AGBs <br /> 0500AGB 0500AGJ 13500AGJs 0250AGB 0250CGB 0250CGBs 01PB ❑500PB ❑500PBna <br /> 0250PB 0250PBn 0125PB 0125PBznna 11100PJ 11100PJna2 ❑ ❑ ❑ <br /> Air: ❑Tedlaro ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by:Irz <br /> Container: C:Clear A:Amber P:Plastic G: Glass J:Jar B:Bottle Z:Ziploo/Ressalable Beg E: Envelope Reviewed by: <br /> Preservative: h:HCL n:HNO. naa:NarS¢03 na:NaOH P:H.PO. a:H.SO4 Znna:ZnAc,,NaOH f:Fleur-Nterea Scanned by: <br /> 90P 7100-090(05110/101 <br />