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Sample Condition Upon Receipt Pace Analytical Services,Inc. <br /> 1241 Bellevue Street,Suite 9 <br /> aceAnalyticaln Green Bay,WI 54302 <br /> , <br /> Project#:-' WOW 40130276 <br /> Client Name: P X1.2 a DO oji cht . <br /> Courier: r Fed Ex <br /> l` us Client r Pace Plher:as [13Q( 1�1 1111 IIIIIIIIII1 I� liii <br /> Tracking#: _�f' <br /> Custody Seal on Cooler/Box Present: Vyes '":no seals intact: yes r no 40130276 <br /> Custody Seal on Samples Present: r yes trek) Seals intact: r yes - no <br /> Packing Material: 1/Bubble Wrap "'Bubble Bags r None . r Other <br /> Thermometer Used KM Type of Ice: et Blue Dry None 1Samples on ice,cooling process has begun <br /> Cooler Temperature Uncorr: /Corr: l Biological Tissue is Frozen: r yes <br /> Temp Blank Present: r yes no r no Person�JJ��a�� 1' g contents: <br /> Temp should be above freezing to 6°C for all sample except Biota. <br /> Date: 7f(Il <br /> Frozen Biota Samples should be received s 0°C. Comments: nitials: <br /> Chain of Custody Present: .I 'es ONo ON/A 1. rr;;�� `' <br /> Chain of Custody Filled Out: Oyes fAlo ON/A 2, nG ec 1leCt times v &f, 4 61lb <br /> Chain of Custody Relinquished: ZiYes ONo ON/A 3. 1 <br /> Sampler Name&Signature on COC: .ZYes ONo ON/A 4. <br /> Samples Arrived within Hold Time: tE9rss 0 ON/A 5.0_0\�. c.-m -t �Sd <br /> -VOA Samples frozen upon receipt 0 `�»Y� ONo Date/Time: ieog 4ttst(Ry <br /> Short Hold Time Anal is <72hr): ' _ r , ON/A ;, s,,kmit- 4 . , 1 0 <br /> Rush Turn Around Time Requested: OYes I,QNo ON/A 7, <br /> Sufficient Volume: VgYes ONo ON/A,8. �- + <br /> Correct Containers Used: -A f; glow%tea <br /> g. O S�i,C., voNum■-� C2CezUQd uU1��C e.sts C <br /> -Pace Containers Used: :Yes ON/A <br /> -Pace IR Containers Used: °Yes ONo • ■A 4 4 _ (Ca <br /> Containers Intact: f res ONo ON/A 10. <br /> Filtered volume received for Dissolved tests OYes ONo 94/A 11. <br /> Sample Labels match COC: pKes ONo ON/A 12. <br /> -Includes date/time/ID/Analysis Matrix: l,( _ <br /> All containers needing preservation have been checked. <br /> (Non-Compliance noted in 13.) Oyes ONo jN/A 13. r HNO3 O H2SO4 NaOH r NaOH +ZnAct <br /> All containers needing preservation are found to be in 00(4-002- �-� - cx.lt PC'e-e-r Ue6, VO(CAAYI*- d iPett,e)Q <br /> compliance with EPA recommendation. OYes ONo I/A ►nt0 t 2.GX'� L�l7 Q0" <br /> (HNO3,H2SO4 s2• H+ZnAct z9:NaOH_z12)__—-- --_--— -exceptions: VOA, TOC,TOX,TOH, ,,�! Initial when Lab Std#10 of Uate/ <br /> 08G,WIDROW,Pheno-I`�cs, OTHER: SaYes ONo completed 1preservative (Time: i 4( / 10 <br /> Headspace in VOA Vials(>6mm): OYes ONo IIN/A 14. <br /> Trip Blank Present: OYes ONo Ipfi/A 15. <br /> Trip Blank Custody Seals Present OYes ONo pi/A <br /> Pace Trip Blank Lot#(if purchased): <br /> Client Notification/Resolution: If checked,see attached form for additional comments ❑ <br /> Person Contacted: ! Date/Time: <br /> Comments/Resolution: <br /> Project Manager Review: I��t : 1LJ'j, <br /> j' <br /> F-GB-C-03I-Rev.03(9ApriI2015)SCUR Form <br /> Page 11 of 11 <br />