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AF?27;7 FCA F112000 10/1[912022 <br /> BSK Associates SR-FL-0002-23 <br /> i <br /> Sample Inte rity to <br /> BSK Bogle . Yes No Page of _.................................................... <br /> r <br /> Was tempera ure within ge? Were correct containers and preservatives <br /> ChemistryS icro�8"C Yes o NA received for the tests requested? Ye NA <br /> 12 If samples were taken today,is there evidence Bubbles Present VOAs(524.2/TTHMfTCP)? Ye <br /> that chillinghas begun? Yes No NA TB Received? Check Method Below <br /> L) <br /> Did all bottles arrive unbroken and intact? No Was a sufficient amount of sample received? Ye <br /> Did all bottle labels agree with COC? es o Do samples have a hold time<72 hours? es No <br /> Was sodium thiosulfate added to CN sample(s) Was PM notified of discrepancies? <br /> until chlorine was no longer present? Yes NA PM: ByfTime: Yes No NA <br /> 250m1(A)500mt(B) 9Liter(C)40m1VOA(V) f 25m1(D) Check Passed? <br /> Bacti Na2S203 -- — <br /> None(P)Whitecap — — <br /> Cr6(P)Lt' °"labellBlue cep NH40H(NH4)25o4 ow Cl,pH>8 P F <br /> Cr6 (P) Pink Labeli8lue Cap NH40H(NH4)2504 WW pH 9.3-9.7 P F <br /> C(6 (P) Blackl.abet/91ueCap NH40H(NH4)2so4 7199 <br /> c 1 1 . 24 HOUR HOLD TIME— pH 9.0-9.5 P F <br /> HNO3(P)Red Cap or HCI (P)Purple Ca%VL3-Blue Label <br /> E <br /> H2SO4 (P) or (AG) Yell—`380.abel pH<2 P F <br /> NaOH (P)Green Cap Cl, pH >10 P F <br /> m <br /> lEi NaOH+ZnAc(P) pH>9 P F <br /> 0 <br /> Dissolved Oxygen 300ml (g) — <br /> z <br /> None(AG)8081808118082.625.63218321,8151.6270 — <br /> ? HCI (AG)u Biue LabelO&G,Diesel,TCP — <br /> Ascorbic, EDTA, KH2Ct(AG)PtnkLabel 525 — — <br /> Na2SO3 250mL(AG)Neon Green Label 515 — — <br /> Na2S2031 Liter(Brown P)549 — — <br /> Im .o Na2S203(AG)elue Label 548 THM,524 — — <br /> Na2S203(CG)Blue Label 504.505,547 — — <br /> 0 Na2S203+ MCAA(CG)orange Label 531 pH<3 P F <br /> y NH4Cl (AG)Purple Label 552 — — <br /> N <br /> 2 EDA(P) or (AG)Brown Late' DBPs — — <br /> W <br /> HCL(CG)524.2,BTEX.Gas,MTBE,8260/624 — — <br /> Ew Buffer pH 4 (CG) — — <br /> H3PO4(CG)sa"n-Label — — <br /> _� Trizma—EPA 537.1 -Field Blank Required <br /> Other: <br /> Asbestos 1 L P wl Foil / LL Metals Bottle — — <br /> Bottled Water — — <br /> Clear Glass i — — <br /> Solids: Brass 1 Steel 1 Plastic Ba — — <br /> ,, Container Preservative Lot# Initials Date/Time Preservation Check. <br /> S P pH Lot# <br /> S P Ci Lot# <br /> 'Preservation check completed by lab performing analysis. ✓ Indicates Blanks Received <br /> E 504 _ 524.2_ TfHM_ 537.1 _ TCP_ <br /> E <br /> U ✓ MSIMSD Received Method: <br /> Scanned: C71 Rush/Short HT Page: Time: <br /> Page 9of9 <br />