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Page 48 of 4 / tip. e U rof ins lCaIscience WORK ORDER NUMBER: 15-10- o C� SAMPLE RECEIPT CHECKLIST COOLER / OF CLIENT: LQLK _�'C-0 LA DATE: 101 M / 2015 TEMPERATURE: (Criteria: 0.0°C—6.0°C, not frozen except sediment/tissue) 2 , 0 Thermometer ID: SC2(CF:-0.40C);Temperature(w/o CF): a - 4f °C(w/CF): °C; nk ❑ Sample ❑ Sample(s)outside temperature criteria (PM/APM contacted by: ) ❑ Sample(s)outside temperature criteria but received on ice/chilled on same day of sampling ❑ Sample(s)received at ambient temperature; placed on ice for transport by courier Ambient Temperature: ❑Air ❑ Filter Checked by: CUSTODY SEAL Cooler 2.1 resent and Intact ❑ Present but Not Intact ❑ Not Present ❑ N/A Checked by: Sample(s) ❑ Present and Intact ❑ Present but Not Intact Not Present ❑ N/A Checked by: Q�CS SAMPLE CONDITION: Yes No N/A Chain-of-Custody(COC)document(s) received with samples................................................... g ❑ ❑ COC document(s)received complete ................................................................................. ❑ ❑ ❑ Sampling date ❑ Sampling time ❑ Matrix ❑ Number of containers ❑ No analysis requested ❑ Not relinquished ❑ No relinquished date ❑ No relinquished time Sampler's name indicated on COC .................................................................................... .21 ❑ ❑ Sample container label(s)consistent with COC ..................................................................... !� ❑ ❑ 0 Sample containers)intact and in good condition .................................................................. to ❑ ❑ Proper containers for analyses requested ........................................................................... /P1 ❑ ❑ Sufficient volume/mass for analyses requested ................................................I.................... Ll ❑ ❑ Samples received within holding time ................................................................................. ❑ ❑ Aqueous samples for certain analyses received within 15-minute holding time ❑ pH ❑ Residual Chlorine ❑ Dissolved Sulfide ❑ Dissolved Oxygen .............................. ❑ ❑ 10 Proper preservation chemical(s) noted on COC and/or sample container .................................... ,,f ❑ ❑ Unpreserved aqueous sample(s) received for certain analyses ❑ Volatile Organics ❑ Total Metals XDissolved Metals Container(s)for certain analysis free of headspace ............................................................... -4-1 ❑ ❑ ZVolatile Organics ❑ Dissolved Gases (RSK-175) ❑ Dissolved Oxygen(SM 4500) ❑ Carbon Dioxide(SM 4500) ❑ Ferrous Iron (SM 3500) ❑ Hydrogen Sulfide(Hach) TedlarTM bag(s)free of condensation ................................................................................. ❑ ❑ 2/ CONTAINER TYPE: l (Trip Blank Lot Number: i S 611011 ) Aqueous: ❑VOA .12�VOAh ❑VOAna2 ❑ 100PJ ❑ 100PJna2 ❑ 125AGB ❑ 125AGBh ❑ 125AGBp ❑ 125PB ❑ 125PBznna ❑250AGB ❑ 250CGB ❑250CGBs )21 250PB .0250PBn ❑500AGB )P1500AGJ ❑ 500 GJs ❑500PB ❑ 1AGB ❑ 1AGBna2 ❑ 1AGBs PB ❑ 1PBna ❑— 13— 3 ❑ ❑ Solid: ❑4ozCGJ ❑8ozCGJ ❑ 16ozCGJ ❑ Sleeve ( ) ❑ EnCorese�) ❑TerraCoreso( ) 13 Air: ❑Tedlar'rm ❑ Canister ❑Sorbent Tube ❑ PUF ❑ Other Matrix( ): ❑ ❑ Container:A=Amber, B=Bottle,C=Clear, E=Envelope,G=Glass,J=Jar, P=Plastic,and Z=Ziploc/Resealable Bag Preservative:b=buffered,f=filtered,h=HCI, n=HNO3, na=NaOH, nae=Na2S203,p=H3PO4, Labeled/Checked by:40:S s=H2SO4,u =ultra-pure,znna=Zn(CH3CO2)2+NaOH Reviewed by: 6$t 015-04-10 Revision