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Page 28 of 30 <br />0. WORK ORDER #: 10.07- ❑ ❑ D El <br />ZI :4129MOINMI Cooler l of 3 <br />CLIENT: DATE: 0712 -LI 10 <br />TEMPERATURE: Thermometer ID: SC1 (Criteria: 0.0 °C - 6.0 °C, not frozen) <br />Temperature 2 OC + 0.5 OC (CF) _ . IO °C I 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 />MODDY SEALS INTACT: <br />Cooler ❑ ❑ No (Not Intact) ❑ Not Present ❑ N/A Initial: <br />❑ Sample ❑ ❑ No (Not Intact) or Not Present Initial: <br />SAMPLE CONDITION: Yes <br />No <br />N/A <br />Chain -Of -Custody (COC) document(s) received with samples ................... <br />❑ <br />❑ <br />COC document(s) received complete ................................................... <br />2( <br />❑ <br />❑ <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 />❑ <br />❑ <br />2T' <br />Sample container label(s) consistent with COC ..................................... <br />2' <br />❑ <br />❑ <br />Sample container(s) intact and good condition ...................................... <br />❑ <br />❑ <br />Proper containers and sufficient volume for analyses requested ............... <br />E2` <br />❑ <br />❑ <br />Analyses received within holding time .................................................. <br />Z' <br />❑ <br />o <br />pH / Residual Chlorine / Dissolved Sulfide received within 24 hours........... <br />❑ <br />❑ - <br />C�7' <br />Proper preservation noted on COC or sample container .......................... <br />Z <br />❑ <br />❑ <br />❑ Unpreserved vials received for Volatiles analysis <br />Volatile anolysis container(s) free of headspace..................................... <br />❑ <br />❑ <br />Tedlar bag(s) free of condensation...................................................... <br />❑ <br />❑ <br />CONTAINER TYPE: <br />Solid: 134ozCGJ 08ozCGJ 016ozCGJ ❑Sleeve ( ) ❑EnCorese ❑TerraCoreso ❑ <br />01AGBs <br />Water: ❑VOA ❑VOAh ❑VOAna2 0125AGB ❑125AGBh 0125AGBp <br />21-1_& <br />01AGBna2 <br />0500AGB ❑500AGJ 0500AGJs 11250AGB 0250CGB 0250CGBs <br />01PB <br />❑500P6 ❑500PBna <br />❑250PB ❑250PBn ❑ 125PB ❑ 125PBznna ❑ 100PJ ❑ 100PJna2 ❑ <br />❑ <br />❑ <br />Air: ❑Tedlar® ❑Summa° Other: ❑ Trip Blank Lot#: Labeled/Checked by: <br />Container: C: Clear A: Amber P: Plastic G: Glass J: Jar B: Bottle Z: Ziploc/Resealable Bag E: <br />Envelope <br />Reviewed by: <br />Preservative: h: HCL n: HNO3 na2:Na2S203 na: NaOH p: H3PO4 s: H2SO4 znna: ZnAC2+NaOH f: Field -filtered <br />Scanned by: <br />SOP T100 090 (05110110) <br />