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ASL1471 12/12520118 <br /> BSK Associates SR-FL-0002-19 1Vlante8467 } <br /> I' <br /> Sample Integrity <br /> IIIIIIIIIINI NNIININNNINIIIIIININNIII <br /> t <br /> BSK Bottles: a No Page ` of< -- ......... . <br /> Was temperature w n range? Were correct containers and preservatives <br /> Chemist 5 6°C Micro<8°C No NA received for the tests regU sted? NINA <br /> �R If samples were taken today,is there evidence Bubbles Present VOAs(5 4.2rrCP/TTHM)? s qd Up <br /> that chillinghas begun? Yes No N TB Received? Check Me hod Below s q <br /> ODid all bottles arrive unbroken and intact? No Was a sufficient amount o sample received? No <br /> V Did all bottle labels agree with COC? No Do samples have a hold ti a<72 hours? Yes o <br /> Was sodium thiosulfate added to CN sample(s) Yes No A Was PM notified of discre ancies? s No N <br /> until chlorine was no longer present? PM: By/Ti e: <br /> 250ml(A) 500mi(B) 1 Liter(C)40m1 VOA(V) Checks Passed? <br /> ^ <br /> .r a fElm <br /> None(P)white cap — — <br /> I <br /> Cr6 (P) Pink LabelBlue Cap NH40H(NH4)2SO4 WW pH 9.3-9.7 P F <br /> cc <br /> ami HNO3(P)Red cap or HCI(P)Purple Cap/Lt.Blue Label — — <br /> E <br /> IS <br /> a� NaOH (P)Green Cap Cl,pH>10 f P FFEW 1 ME ME <br /> J <br /> to <br /> O <br /> a Dissolved Oxygen 300ml (g) — — <br /> d ? <br /> > s ., <br /> Z 'm HCI(AG)Lt.Blue Label O&G,Diesel,TCP — — <br /> o Ascorbic, EDTA,KH2Ct(AG)Pink Label 525 — — <br /> rn <br /> Y <br /> C U Na2S2O31 Liter(Brown P)549 — — <br /> m ,r. . <br /> 0 <br /> ROOM- <br /> s Na2S203(CG)Blue Label 504,505,547 — — <br /> U <br /> 0 y Fs r^ <br /> y ^NH4CI(AG)Purple Label 552 — — 1 <br /> v tr <br /> m HCL(CG)524.2,BTEX,Gas,MTBE,8260/624 — <br /> E '' f <br /> F- <br /> F <br /> Other: <br /> Bottled Water — — <br /> s <br /> Solids: Brass / Steel / Plastic Bag — — <br /> �, Container Preservative Date/Time/Initials Container (Preservative Date /I itials <br /> CL S P S P <br /> N S P S P <br /> ✓ Indicates Blank$Received <br /> m 504_ 524.2_ TCP— TTHM 537 <br /> E <br /> 8260/624 <br /> I k <br /> Labeled by: ECA @ IIS Labels checked by: @ �b RU 3H Paged by { <br /> Page 18 of 18 <br />