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Page 8 of 8 <br /> WORK ORDER #: 1 1 -1 O-© 0 © 'V <br /> to114641% Inc. ' ' Cooler of / <br /> CLIENT: T"I DATE: 10 // r1l L <br /> TEMPERATURE: Thermometer ID: SC1 (Criteria: 0.0°C-6.0°C, not frozen.)) <br /> Temperature —/--. Z oC + 0.5 eC (CF) _ / .� OC L/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 Initial: <br /> y� <br /> CUSTODY SEALS INTACT: v� <br /> Cooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: <br /> ❑ Sample ❑ ❑ No (Not Intact) ;6 Not Present Initial: <br /> SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody (COC) document(s) received with samples...................X ❑ ❑ <br /> COC document(s) received complete.._._. . _ _.__ __... ❑ ❑ <br /> ❑ Collection date/time, matrix,and/or#of containers logged in based on sample labels. ` <br /> ❑ No analysis requested. ❑ Not relinquished. ❑ No datettime relinquished. <br /> Sampler's name indicated on COC...................................................... ❑ ❑ ;or <br /> Sample container label(s) consistent with COC...................................... PJ ❑ ❑ <br /> Sample container(s) intact and good condition........................... ........... ❑ ❑ <br /> Proper containers and sufficient volume for analyses requested............--e ❑ ❑ <br /> Analyses received within holding time.......__.......................................fX ❑ ❑ <br /> pH / Res. Chlorine/ Diss. Sulfide / Diss. Oxygen received within 24 hours... ❑ ❑ 19 <br /> Proper preservation noted on COC or sample container..........................Z ❑ ❑ <br /> ❑ Unpreserved vials received for Volatiles analysis <br /> Volatile analysis container(s)free of heacispace..................................... ❑ ❑ ,e1 <br /> Tedlar bag(s)free of condensation...................................................... ❑ ❑ <br /> CONTAINER TYPE: <br /> Solid: 1]4ozCGJ 08ozCGJ 016ozCGJ []Sleeve ❑EnCores® ❑TerraCoreso ❑ <br /> Water: ❑VOA ❑VOAh 0VOAna2 0125AGB ❑125AGBh 0125AGBp J lAGB ❑1AGBna2 ❑1AGBs <br /> 0500AGB 0500AGJ 0500AGJs 0250AGB 0250CGB 0250CGBs ❑1PB 01PBna 0500PB <br /> 0250PB 0250PBn 0125PB 0125PBznna 0100PJ 0100PJna2 ❑ ❑ ❑ <br /> Air: ❑Tedlar® ❑Summa® Other: ❑ Trip Blank Lot#: Labeled/Checked by M <br /> Container. C:Clear A.Amber P:Plastic G:Glass J:Jar B:Bottle Z:ZiplodResealable Bag E:Envelope Reviewed by: 9-7 <br /> Preservative: h:HCL n:HNO3 na2:Na2S203 na:NaOH p:H3PO4 s:H2SO4 u:Ultra-pure znna:ZnAce*NaOH f:Filtered Scanned by: <br /> sor Tt00_oso(ryomam) <br />