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:1 e u rof ins WORK ORDER NUMBER: Calscience _ SAMPLE RECEIPT CHECKLIST COOLER OF CLIENT: 1— DATE: 01 /3) / 2019 TEMPERATURE: (Criteria: 0.0°C—6.0°C, not frozen except sediment/tissue) Thermometer ID: SC6 (CF: -0.50C); Temperature(w/o CF): A- _7L °C (w/CF): °C; ❑ Blank "0'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 ❑ Present and Intact ❑ Present but Not Intact 10�otPresent ❑ N/A Checked by: 15 Sample(s) ❑ Present and Intact ❑ Present but Not Intact of Present ❑ N/A Checked by: SAMPLE CONDITION: Yes No N/A Chain-of-Custody(COC)document(s) received with samples................................................... ❑ ❑ 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 .................................................................................... ❑ ❑ Sample container label(s)consistent with COC ..................................................................... ❑ ❑ Sample container(s) intact and in good condition ....................:............................................. ❑ ❑ v Proper containers for analyses requested .......................................................I................... ❑ ❑ Sufficient volume/mass for analyses requested ..................................................................... ❑ ❑ Samples received within holding time ................................................................................. ❑ ❑ r Aqueous samples for certain analyses received within 15-minute holding time ❑ pH ❑ Residual Chlorine ❑ Dissolved Sulfide ❑ Dissolved Oxygen .............................. ❑ ❑ Proper preservation chemical(s) noted on COC and/or sample container .................................... ❑ ❑ Unpreserved aqueous sample(s) received for certain analyses ❑ Volatile Organics ❑ Total Metals ❑ Dissolved Metals Acid/base preserved samples- pH within acceptable range ..................................................... ❑ ❑ Container(s)for certain analysis free of headspace.................................................................. ❑ ❑ ❑Volatile 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 ................................................................................. ❑ ❑ CONTAINER TYPE: (Trip Blank Lot Number: ) Aqueous: ❑VOA ❑VOAh ❑VOAna2 ❑ 100PJ ❑ 100PJna2 ❑ 125AGB ❑ 125AGBh ❑ 125AGBp ❑ 125PB ❑ 125PBznna(pH_9) ❑250AGB ❑250CGB ❑250CGBs(pH-2) ❑250PB ❑250PBn(pH_2) ❑500AGB ❑500AGJ ❑500AGJs(pH-2) ❑500PB ❑ 1AGB ❑ 1AGBna2 1AGBs(pH-2) ❑ 1AGBs(O&G)❑ 1P6 ❑ 1PBna(pH_12) ❑ ❑ ❑ Solid: ❑4ozCGJ 8ozCGJ ❑ 16ozCGJ ❑Sleeve(_) ❑ EnCores9(_) ❑TerraCores®(_)❑ ❑ ❑ 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. s= H2SO4, u=ultra-pure, x= Na2SO3+NaHSO4.H2O,znna=Zn(CH3CO2)2+NaOH Reviewed by: 2017-08-29 Revision