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e u rof i ns f WORK ORDER NUMBER: pj 00 1� C I Caiscience SAMPLE RECEIPT CHECKLIST COOLER i OF I CLIENT: E �1_L_ DATE: 12 / / 2017 TEMPERATURE: (Criteria: 0.0°C — 6.0°C, not frozen except sediment/tissue) Thermometer ID: SC6 (CF: -0.4°C); Temperature (w/o CF): 2 - S�" °C (w/ CF): 2 , °C; ❑ Blank atample ❑ Sample(s) outside temperature criteria (PM/APM contacted by: ) ❑ Sample(s) outside temperature criteria but re�eived on ice/chilled on same day of sampling t ❑ Sample(s) received at ambient temperature; placed on ice for transport by courier Ambient Temperature: 0 Air ❑ Filter i Checked by: CUSTODY SEAL: Cooler ❑ Present and Intact ❑ Present but Not Intact >0'Not Present ❑ N/A Checked by: Sample(s) ❑ Present and Intact ❑ Present but Not Intact E� Not Present 0 N/A Checked by: � SAMPLE CONDITION: Yes No N/A Chain -of -Custody (COC) document(s) received with samples ................................................... ❑ ❑ COC document(s) received complete.................I ................................................................ ❑ ❑ ❑ Sampling date ❑ Sampling time ❑ Matrix i0 Number of containers r ❑ No analysis requested ❑ Not relinquished] No relinquished date ❑ No relinquished time Sampler's name indicated on COC ................................................................................... m ❑ ❑ Sample container label(s) consistent with COC.....f................................................................ [A ❑ ❑ Sample container(s) intact and in good condition.�................................................................ 13 ❑ Proper containers for analyses requested...........}................................................................ ❑ ❑ Sufficient volume/mass for analyses requested................................................................... ' LTJ ❑ ❑ I Samples received within holding time................!................................................................ �ithin Jr� ❑ ❑ Aqueous samples for certain analyses received 15 -minute holding time ❑ pH ❑ Residual Chlorine ❑ Dissolved Sulfije ❑ Dissolved Oxygen .............................. ❑ ❑ i Proper preservation chemical(s) noted on COC and/or sample container .................................... ❑ ❑ Unpreserved aqueous sample(s) received for certain analyses ❑ Volatile Organics ❑ Total Metals 0 Dissolved Metals Acid/base preserved samples - pH within acceptable range ..................................................... ❑ ❑ Container(s) for certain analysis free of headspace4................................................................ ❑ ❑ ❑ Volatile Organics ❑ Dissolved Gases (RSK-175) 0 Dissolved Oxygen (SM 4500) ❑ Carbon Dioxide (SM 4500) ❑ Ferrous Iron (SM 3500) ❑ Hydrogen Sulfide (Hach) TedlarTm bag(s) free of condensation................................................................................. ❑ ❑ m 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 U�1AGB ❑ 1AGBna2 ❑ 1AGBs (pH_2) ❑ 1AGBs (0&G) ❑ 1PB ❑ 1PBna (pH_12) ❑ ❑ ❑ Solid: ❑ 4ozCGJ ❑ 8ozCGJ ❑ 16ozCGJ ❑ Sleeve (_) ❑ EnCoree (_) ❑ TerraCoreso L_) ❑ ❑ ❑ Air: ❑ TedlarIm ❑ 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 = HNOL na = NaOH, nae = Na2S203, p = H3PO4, Labeled/Checked by: 72L I s = H2SO4, u = ultra -pure, x = Na2SO3+NaHSO4.H2O, znna = Zn (CH3CO2)2 + NaOH Reviewed by: 0 S 2017-08-29 Revision