sampling data regarding shpack dump, case # 01318
TRANSCRIPT
SHPACK DUMP
CASE 01318
LAB COMPUCHEM LABS
SAMPLING DATES 0908 - 092082
(PART 1 OF 1 )
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(Cl ieck One)
LOW CJoncentration ffjft ^ if^CJC^ t Sample Site NameCode Mediu im Concentration
Attn SEP 2 7 1982 copy SAMPLEM ATRIX
(Check One) bull Transfer
gt WaterSoiia sdiment Ship To TP
0^lt-AAJ copy Regional Office- copy Por each sample collected sp ecify number (u) AnalysraquoLab Sampling Personnel of containers used and markvolume level Recd byY iX^SSLCL
on each bottle )ate Reed- Cgt3OltS
3-pt 7ykfi sample Condition on Receipt (eg broken n r JNaine) Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
(Phone) Water j gt Sampling Date (Extractable)
Water (Begin (find) (VOA) j W copy Shipping Information Soil Sediment
Water (ExtVOA)
Name of Camer Other
3X f ^ Date Shipped
Airbill Number
reg Sample Description copy Sample Location
Surface Water Mixed Media 7shy Ground Water Solids
I eachate Other (specify)
Special Handling Instructions (e g safety precautions hazardous nature)
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m ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNsme QC REQUIREMENTS SAMPLE CONCENTRATION
Case No bull 3(b Designate below OC (Check One)
ST jraquoh Sample ID No
analysis selected (If Applicable)
Low Concentration Medium Concentration
QC Report No Dunlicate SAMPLE MATRIX n (Check ftfl) OlW
Matrix Spike Water Soil Sfidirnent
Description Technician Signature Detail Below Pertinent Information and or DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation(Dioxins)
Preparation(VGA)
XT
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number D O Box 88 Alexcundria Virginia 22313 -703 557-2490 -FTS557-2490
8tLj ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
I ah Name QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Cjifst Nn Df^ciignatfihfilow QC
Itnln Sample in NOanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report Nn HT mlirate 0 SAMPLE MATRIX V 09 (Check One)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1262 ORGANICSi TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office _JL Sampling Personnel
(Name) a ft i ~4
(Phone) Sampling Date
y(Begin) (End)
copy Shipping Information
Name of Garner
Date Shipped
Airbill Number
(f) Sample Description
Surf ace Water
^_ Ground Water
Leachate
copy SAMPLE CONCENTRATION Ship To bull (Check One)
Low Concentration Medium Concentration SEP2713tt
SAMPLE MATRIX Attn^ bull bull Lt 1
(Check One)
_ Water Transfer
SoilSediment
(D For each sample collected specify number Analjrsis Lab of containers used and mark volume level Recd on each bottle Date Recd
Sample Condition Oil Receipt (eg broken nNumber of Approximateice Chain-of-Custcdy etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
Qo) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No _
gt Sample ID No
lo Designate below QC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check
Matrix Spike __ Water __ SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
(
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides)
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
-60 S US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO K c x H l H AV-varvlna Virginia22313 703557-249OFTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
I ah Name QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HaseNo
Lah Sample ID No
r)pgtsigrifltlt=gt helow QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QT Report No HT inliratft flQi SAMPLE MATRIX OQ (Check One)
Matrix Spike Water
raquo lt
SoilSediment
D nnntion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins bull
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1263 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
(B) Regional Office I Sampling Personnel
(Name)
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
v M - V l ( ^ -raquogt
Name of Camer
Date Shipped
Airbill Number
(D Sample Description
Surface Water
Ground Water
Leachate
(D SAMPLE CC DNCENTRATION (Clieck One)
t
bull LowC Joncentration Mediu im Concentration
(D SAMPLEM ATRIX (Check One) bullraquo
Water Soila kliment
0 Ship To
SEP 2 7 1982 Attn ^ A (
Transfer _ ^
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of containers used and mark volume level Rlaquor-H KyHy X Sk^vSOil
on each bottle Date RlaquovH ^ vQ^Roi Sample Condition
Number of Approximate on Receipt (eg broken no Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) J
Water (VOA)
^
Soil Sediment
Water (Ext VOA)
Other
Mixed Media
Solids
Other (specify)
V
lt r M
(D Sample Location
(jo) Special Handling Instructions (eg safety precautions hazardous nature)
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^SlU ORGANICS LABORATORY CHRONICLE (EXTRACTIONS) HHHIi
T^hName I QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No - Designate below QC analysis selected Low Conrpmtration
T rraquoh Sample ID No (Tf Applicable) Medium Concentration
QH Report No Di mlirate SAMPLE MATRIX (Check One) - ^
Matrix Spike Water HSJt ^ Soil Serhrn Pgtn t
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
f
f gtfExtractionPreparation(Dioxins)
f
Preparation(VGA)
t
f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
1TOCT| US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^mamtnteammm
Kii8 ORGANICS LABORATORY CHRONICLE (ANALYSIS) HUH
Lh NAme QH REQI IIREMENTS SAMPLE CONCENTRATION (Check One)
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I rah Sample ID No (Tf Applicable) Medium Concentration
QC Report No Hi mlirwta ^ SAMPLE MATRIX
Matrix Spike V 9 7n (Check One)
WQg Water SoilSediment
Df^rTintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1264 ORGANICS TRAFFIC REPORT J) Case Number
i
Sample Site NameCode
copy Regional Office Sampling Personnel
(Name) II- - (
(Phone) Sampling Date
(Begin) (End)
0 Shipping Information
A A f
Name of Carrier
Date Shipped
Airbill Number
(s) Sample Description
f Surface Water
ltL- Ground Water
Leachate
SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration
Attn pound SEP 27 SAMPLE MATRIX
(Check One) Transfer
Water SoilSediment Ship To 223
C For each sample collected specify number 1of containers used and mark volume level Recd by^ on each bottle hate R^
Sample Condition on Receipt (eg broken nNumber of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
Special Handling Instructions (eg safety precautions hazardous nature)
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T^hNamJ 1 QC REQUIREMENTS -m -m SAMPLE CONCENTRATION (Check One)
Case No V Designate below OC
T Ah Sample ID Npanalysis selected
(Tf Applicable) Low Concentration Medium Cnnrfiritrfltion
QC Report N^ Hi mliratfi SAMPLE MATRIX (Check One)
Matrix Spike WatorSoilSediment W ^n
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
i
Preparation
(VOA) lt f
shyi iv M-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office -pound Sampling Personnel
(Name) I I bull l t - bull (
(Phone) Sampling Date
(Begin) (End)
(T) Shipping Information
Name of Carrier
Date Shipped
Airbill Number
Sample Description
Surf ace Water
Ground Water
Leachate
SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
Ship To SoilSediment
Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
ice Chain-of-Custody eta) Containers Total Volume
Water i(Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids K
Other (specify)
(To) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T ah Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No gt v Designate below OC analysis selected Low Concentration
Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
^ t
Preparation -^ (VGA) f i
f f+V- r ttfs r
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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mdash| T h Namlaquo i - QC REQUIREMENTS SAMPLE CONCENTRATION
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r SAMPLE MATRIX
reg19Q$Matrix Spike Water SoilSediment
D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
j
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office _Z Sampling Personnel
( j JName)
(Phone)
Sampling Date
(Begin) (End)
0 Shipping Information
1 K i t bull (t
Name of Carrier
Date Shipped
j i
Airbill Number
(|) Sample Description
Surface Water
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T earhate
copy SAMPLE C( DNCENTRATION 0 Ship To (Cl ieck One)
LowC Concentration Mediu im Concentration
Attn ^gt t r v l xy (f) SAMPLEM ATRIX
(Check Craquone) v Transfer
Water SoilS sdiment Ship To Lj r ^ )
(D For each sample collected sp ecify number (n) AnalysisLab i of containers used and markvolume level FWd Ky ^njc^KcL on each bottle DateRecd- ^^^-^J
on Receipt (sfj hmkm no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water -(Extractable)
Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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Hl^f ORGANICS LABORATORY CHRONICLE (EXTRACTIONS) HUH i-V
T ah Name f QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No bull_ V Designate below OC analysis selected Low Concentration
I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
1 f
ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
f
f sOti i
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
LowC loncentration Sample Site NameCode Mediu im Concentratic gt SEP 27 1982
Attn K bull - copy SAMPLEM ATRIX
(Check One) Transfer
^L Water SoiVS sdiment ShipTo $J(0
copy Regional Office 4- copy For each sample collected sp ecify number copy Analysis Lab j Sainpling Personnel of containers used and mark volume level Rlaquonrl Hy^T) l^^S^lu
on each bottle Date R^rl-^-jfD^^ L bull ^ ( Sample Condition
(Name) Approximate On Receipt (eg broken no 1 Number of
i bull - Containers Total Volume ice Chain-of-Custody etc)
(Phone) Water j 1 bull Sampling Date (Extractable) gt bull Water
J (Begin) (End) (VOA) v
Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
Date Shipped
h
Airbill Number
reg Sample Description copy Sample Location
Surface Water Mixed Media
firmrnri Water Sohds
Leachate Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
1
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
i bullbull
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullB l US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^KpHHRjllMg
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
Casft No Dp-RirjnatA helow QC analysis performed Low Concentration
Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
f
ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
S f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
-7 J i bull bull (Name)
(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
Tc i bull i v i Name of Carrier
Date Shipped
t 4 i
Airbill Number
Sample Description
Surf are Water
y Ground Water
Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
(Check One) Transfer
lt Water Cl_- Tgt ^)gt O jf
SoilSi sdiment Ship To Jgt7 nf )f
copy For each sample collected sp ecify number (n) Analysis Lab of containers used and markvolume level RlaquooH hy ^JVj (^5Scdj
on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
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Name of Carrier
Date Shipped
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Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
copy SAMPLE CC gtNCENTRATION 0 Ship To (Cl ieck One)
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0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
SoilSlt adiment
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Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
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(Begin) (End)
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Name of Carrier
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Airbill Number
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Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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I ah Sample in NOanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
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Airbill Number
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0 SAMPLE CC 3NCENTRATION (Cl ieck One)
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Sample Condittom on Receipt (eg broken nc Number of Approximate
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Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
Other (specify)
Ship To If ft f
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Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
y^ US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number A PO Box 818 AlexandriaVirginia22313-703557-249OFTS 557-2490 is
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
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(3) SAMPLE MATRIX (Check One)
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Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
~~| T Ah NATTIlaquo QC REQUIREMENTS SAMPLE CONCENTRATION
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analysis performed Low Concentration Lab Sample ID No (Tf Applicable) Medium Concentration
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
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(Begin) (End)
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
(laquoraquo Mr Dfisignate helow QC
T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
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Surface Water r Ground Water
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(specify) MATCHES ORGANir SAMPLF NO
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Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
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(B) Mark Volume Level On Sample Bottle Check Analysis required
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LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
Sample Site NameCode
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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Sampling Personnel
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(Phone) Sampling Date
(Begin) (End)
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Description Technician Signature Detail Below Pertinent Information and or DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation(Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number D O Box 88 Alexcundria Virginia 22313 -703 557-2490 -FTS557-2490
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Itnln Sample in NOanalysis performed
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QT Report Nn HT mlirate 0 SAMPLE MATRIX V 09 (Check One)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Site NameCode
copy Regional Office _JL Sampling Personnel
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Sample Condition Oil Receipt (eg broken nNumber of Approximateice Chain-of-Custcdy etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
Qo) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION
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Low Concentration Medium Concentration
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides)
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins bull
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1263 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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(Begin) (End)
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Water (VOA)
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T rraquoh Sample ID No (Tf Applicable) Medium Concentration
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Matrix Spike Water HSJt ^ Soil Serhrn Pgtn t
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
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Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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QC Report No Hi mlirwta ^ SAMPLE MATRIX
Matrix Spike V 9 7n (Check One)
WQg Water SoilSediment
Df^rTintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Site NameCode
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0 Shipping Information
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(s) Sample Description
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Low Concentration Medium Concentration
Attn pound SEP 27 SAMPLE MATRIX
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C For each sample collected specify number 1of containers used and mark volume level Recd by^ on each bottle hate R^
Sample Condition on Receipt (eg broken nNumber of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
Special Handling Instructions (eg safety precautions hazardous nature)
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Matrix Spike WatorSoilSediment W ^n
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
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Preparation
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office -pound Sampling Personnel
(Name) I I bull l t - bull (
(Phone) Sampling Date
(Begin) (End)
(T) Shipping Information
Name of Carrier
Date Shipped
Airbill Number
Sample Description
Surf ace Water
Ground Water
Leachate
SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
Ship To SoilSediment
Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
ice Chain-of-Custody eta) Containers Total Volume
Water i(Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids K
Other (specify)
(To) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T ah Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No gt v Designate below OC analysis selected Low Concentration
Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BPH| US ENVIRONMENTAL PROTECnON AGENCY HWISomj iPiimISiigi ORGANICS LABORATORY CHRONICLE (j
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D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office _Z Sampling Personnel
( j JName)
(Phone)
Sampling Date
(Begin) (End)
0 Shipping Information
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Name of Carrier
Date Shipped
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Airbill Number
(|) Sample Description
Surface Water
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LowC Concentration Mediu im Concentration
Attn ^gt t r v l xy (f) SAMPLEM ATRIX
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(D For each sample collected sp ecify number (n) AnalysisLab i of containers used and markvolume level FWd Ky ^njc^KcL on each bottle DateRecd- ^^^-^J
on Receipt (sfj hmkm no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water -(Extractable)
Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
Other (specify)
(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
1 f
ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
LowC loncentration Sample Site NameCode Mediu im Concentratic gt SEP 27 1982
Attn K bull - copy SAMPLEM ATRIX
(Check One) Transfer
^L Water SoiVS sdiment ShipTo $J(0
copy Regional Office 4- copy For each sample collected sp ecify number copy Analysis Lab j Sainpling Personnel of containers used and mark volume level Rlaquonrl Hy^T) l^^S^lu
on each bottle Date R^rl-^-jfD^^ L bull ^ ( Sample Condition
(Name) Approximate On Receipt (eg broken no 1 Number of
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(Phone) Water j 1 bull Sampling Date (Extractable) gt bull Water
J (Begin) (End) (VOA) v
Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
Date Shipped
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Airbill Number
reg Sample Description copy Sample Location
Surface Water Mixed Media
firmrnri Water Sohds
Leachate Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office PC rxvcHht Vxin-n t V i ru in i Z3 i i 703 ^77490-ITo SIv90 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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KM^ OHGANICS LABORATORY CHRONICLE (ANALYSIS) ^H^^l ^Ht^^^ijB bull
Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
Casft No Dp-RirjnatA helow QC analysis performed Low Concentration
Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
f
ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
-7 J i bull bull (Name)
(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
Tc i bull i v i Name of Carrier
Date Shipped
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Airbill Number
Sample Description
Surf are Water
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Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
(Check One) Transfer
lt Water Cl_- Tgt ^)gt O jf
SoilSi sdiment Ship To Jgt7 nf )f
copy For each sample collected sp ecify number (n) Analysis Lab of containers used and markvolume level RlaquooH hy ^JVj (^5Scdj
on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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KiBJgll ORGANTCS LABORATORY CHRONICLE (EXTRACTIONS) ^jjjjjlj^
I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
| gt i t
Name of Carrier
Date Shipped
--
Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
copy SAMPLE CC gtNCENTRATION 0 Ship To (Cl ieck One)
y LowC loncentration Mediu im Concentration SEP 27 1981
0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
SoilSlt adiment
0 For each sample collected sp ecify number AnalysisLab of containers used and mark volume level on each bottle Date Rflcd- lt poundyenpound
Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull y Ai gt ci V r IK H ij K7 Xvjl l - i l V b)7 2490 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HAQA Nrt ppHsignatfi below QC
T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
T flb Sample TD Nn
Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
tt7 $~poundgt6amp (Phone)
(Begin) (End)
0 Shipping Information
Name of Carrier
asf-z Date Shipped
Airbill Number
reg Sample Description
Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
CvJi^shy
(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullbullbull US ENVIRONMENTAL PROTECTION AGENCY HWISomf BtlaquolH PO Box 8 1 8 Alexandria Virginia 223 13-703 557-2490 FTS 557-2490 mmn ~
iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
r^sgt TSIn noltignfli-ft below QC
I ah Sample in NOanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
bull7 o gt z Date Snipped
Airbill Number
0 Sample Description
Surface Water bull Ground Water
Learhate
0 SAMPLE CC 3NCENTRATION (Cl ieck One)
LowC Concentration Mediu m Concentration
0 SAMPLE MATRIX (Check Otae) t
bull Water SouS adiment
^^ A
0 For each sample collected sp ecify number (TT) Analynifi LiAb i of containers used and mark volume level pLrl hyy^7-^ltSr flL on each bottle Date R H- 9 -f^^
Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
f
ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
I
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
y^ US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number A PO Box 818 AlexandriaVirginia22313-703557-249OFTS 557-2490 is
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
ltc M SVC lt r J
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
bullH l US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^^gmmimfim
Hi ORGANTCS LABORATORY CHRONICLE (EXTRACTIONS) BHDIi
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No - ~- Designate below OC analysis selected Low Concentration
T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
- bull 1 t
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
~~| T Ah NATTIlaquo QC REQUIREMENTS SAMPLE CONCENTRATION
(Check One) HARA Nn Designate below QC
analysis performed Low Concentration Lab Sample ID No (Tf Applicable) Medium Concentration
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
jMf^yampH(Phone)
Sampling Date
(Begin) (End)
copy Shipping Information
JfoJWampi fjiampt faZ1
Name of Carrier
Date Shipped
poundC) ~j ltypound
Airbill Number
copy Sample Description
Surface Water
V firoiinH Water
Leachate
copy SAMPLE C( DNCENTRATION copy Ship To Of bull tlt (Cl leckOne) bullgtbull V C( ty finlt- ty
Y LowC Concentration ^ ^JfX J r Mediu im Concentration rr ^riy ^ A ^ ^ bull lfr ~ lt ^
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copy SAMPLEM ATRIX ^mmmm^fpoundmmampltmm JCheck O
Transfer SEP 27 I9ff V Water Cl_ bull T1 ^T l 1 ^bhlP rdegSoilS ediment ^ff 0 j I
copy For each sample collected sp ecify number (n) AnalysisLab bullbull of containers used and mark volume level on each bottle Date RACU- 7^5SJ
ij|fimT3ft ^^oncntioii on Receipt (eg broken ac Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) a I11
Water (VOA) 2 ^lt
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Other
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Solids
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Name Of Carrier
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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QC Report No Dunlicate SAMPLE MATRIX n (Check ftfl) OlW
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Description Technician Signature Detail Below Pertinent Information and or DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation(Dioxins)
Preparation(VGA)
XT
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number D O Box 88 Alexcundria Virginia 22313 -703 557-2490 -FTS557-2490
8tLj ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
I ah Name QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1262 ORGANICSi TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office _JL Sampling Personnel
(Name) a ft i ~4
(Phone) Sampling Date
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Name of Garner
Date Shipped
Airbill Number
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Surf ace Water
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Low Concentration Medium Concentration SEP2713tt
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Sample Condition Oil Receipt (eg broken nNumber of Approximateice Chain-of-Custcdy etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
Qo) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No _
gt Sample ID No
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(If Applicable)
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Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check
Matrix Spike __ Water __ SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
(
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides)
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
-60 S US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO K c x H l H AV-varvlna Virginia22313 703557-249OFTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
I ah Name QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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(If Applicable) Low Concentration Medium Concentration
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Matrix Spike Water
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SoilSediment
D nnntion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins bull
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1263 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
(B) Regional Office I Sampling Personnel
(Name)
(Phone)
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(Begin) (End)
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v M - V l ( ^ -raquogt
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Number of Approximate on Receipt (eg broken no Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) J
Water (VOA)
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Soil Sediment
Water (Ext VOA)
Other
Mixed Media
Solids
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V
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(D Sample Location
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T^hName I QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No - Designate below QC analysis selected Low Conrpmtration
T rraquoh Sample ID No (Tf Applicable) Medium Concentration
QH Report No Di mlirate SAMPLE MATRIX (Check One) - ^
Matrix Spike Water HSJt ^ Soil Serhrn Pgtn t
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
f
f gtfExtractionPreparation(Dioxins)
f
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
1TOCT| US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^mamtnteammm
Kii8 ORGANICS LABORATORY CHRONICLE (ANALYSIS) HUH
Lh NAme QH REQI IIREMENTS SAMPLE CONCENTRATION (Check One)
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QC Report No Hi mlirwta ^ SAMPLE MATRIX
Matrix Spike V 9 7n (Check One)
WQg Water SoilSediment
Df^rTintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1264 ORGANICS TRAFFIC REPORT J) Case Number
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Sample Site NameCode
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(Phone) Sampling Date
(Begin) (End)
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Name of Carrier
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Water (VOA)
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Special Handling Instructions (eg safety precautions hazardous nature)
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QC Report N^ Hi mliratfi SAMPLE MATRIX (Check One)
Matrix Spike WatorSoilSediment W ^n
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
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Preparation
(VOA) lt f
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office -pound Sampling Personnel
(Name) I I bull l t - bull (
(Phone) Sampling Date
(Begin) (End)
(T) Shipping Information
Name of Carrier
Date Shipped
Airbill Number
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Surf ace Water
Ground Water
Leachate
SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
Ship To SoilSediment
Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
ice Chain-of-Custody eta) Containers Total Volume
Water i(Extractable)
Water (VOA)
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Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids K
Other (specify)
(To) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T ah Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No gt v Designate below OC analysis selected Low Concentration
Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Name of Carrier
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Airbill Number
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Surface Water
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LowC Concentration Mediu im Concentration
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Water -(Extractable)
Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
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(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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Case No bull_ V Designate below OC analysis selected Low Concentration
I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
1 f
ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
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Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
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SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
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(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
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Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
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Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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SoilSediment
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Mixed Media
Solids
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Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
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(Phone) Sampling Date y i i gt
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Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
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Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
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Mixed Media
Solid
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copy Special Handling Instructions (eg safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
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SAMPLE MATRIX (Check One)
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Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
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) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
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Airbill Number
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Sample Condittom on Receipt (eg broken nc Number of Approximate
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SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
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Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
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Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
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Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
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Sample Site NameCode
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Sampling Date
(Begin) (End)
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(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
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Sampling Date
(Begin) (End)
copy Shipping Information
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Name of Carrier
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Water (VOA) 2 ^lt
SoilSediment
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copy Sample Location
Mixed Media
Solids
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QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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Sampling Personnel
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(Phone) Sampling Date
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Surface Water r Ground Water
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(specify) MATCHES ORGANir SAMPLF NO
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Low Cuuctmlidliuii
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Name Of Carrier
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(B) Mark Volume Level On Sample Bottle Check Analysis required
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LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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MATCHES ORGANIC SAMPLE NO -t-ii
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Sample Condition On Receipt
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
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LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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(Phone) Sampling Date
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Low Concentration
0 SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
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TOC _-_ Fluoride amp pH
LAB FILE COPY
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
Sulfade Cyanide
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LAB FILE COPY
Sample Number
IMA 8876
() Ship To
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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IA 8877 INORGANICS TRAFFIC REPORT reg Case Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
rub^vcU Alexandria VA22313 703 557-2490-FTS 5572490 IMA SSTS PRddeg INORGANICS TRAFHC REPORT
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Sampling Personnel Name Of Carrier
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Airbill MiimhfiTshy
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office PO Bo
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Task 1 amp 2 Tank 3 Ammonia
Sulhde Solids Cyanide Other Tor (specify)
_ FtiirH^pH MATCHES ORGANIC S AMPT R NO _
LAB FILE COPY
(4) Ship To - 1 A
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(9) ANALYSIS LAB
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
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(Phone) Sampling Date
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Sample Description copy (Check One) Surface Water OiroTinH Writer
_____ Solids OHi(=r
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SAMPLE CONCENTRATION (Check One)
Low CunceutidLiou
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Water SoilSedirnpnt
(e) Shipping Information
Name Of Carrier s
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Airhill Niimhfir
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Sulfide Cyanide
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LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Low Concentration
reg SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier f t flt f raquo - f
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Airbil l NiimhRr
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LAB FILE COPY
0 Ship To
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R0H hy f
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
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(5) SAMPLE MATRIX (Check One)
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Name Of Carrier
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LAB FILE COPY
(5) Ship To v^1 A
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TD u raquo A r lt pprrl hy
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
SSJ IA 8883 INORGANICS TRAFnC REPORT 0 SAMPLE CONCENTRATION (T) Case Number _ bdquo 0 Ship To shy
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Sampling Personnel Name Of Carrier it
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Burfarp Water Check Analysis required laquo GifounH Wfltpr - lt - Cs_i_ Task 1 amp 2
Tflsk 3 Ammonia Sulfide Solids
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number D O Box 88 Alexcundria Virginia 22313 -703 557-2490 -FTS557-2490
8tLj ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1262 ORGANICSi TRAFFIC REPORT T) Case Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
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Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides)
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins bull
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1263 ORGANICS TRAFFIC REPORT (T) Case Number
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Matrix Spike Water HSJt ^ Soil Serhrn Pgtn t
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Df^rTintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1264 ORGANICS TRAFFIC REPORT J) Case Number
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ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
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Preparation
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
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Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
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Matrix Spike Water WN 01laquo SoilSediment
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ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
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ExtractionPreparation(Acid)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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(10) Special Handling Instructions (eg safety precautions hazardous nature)
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Case No
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
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ExtractionPreparation (Acid)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Matrix Spike Water
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
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BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
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(Begin) (End)
0 Shipping Information
Name of Carrier
asf-z Date Shipped
Airbill Number
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Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
CvJi^shy
(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
r^sgt TSIn noltignfli-ft below QC
I ah Sample in NOanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
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Airbill Number
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0 SAMPLE CC 3NCENTRATION (Cl ieck One)
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Sample Condittom on Receipt (eg broken nc Number of Approximate
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Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
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wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
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Sampling Date
(Begin) (End)
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copy SAMPLE CONCENTRATION (Check One)
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(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
Other (specify)
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T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
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QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
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Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
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Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Attn
Transfer Ship To
0 ANALYSIS LAB
Perrj by
DarfiRfirH- ~~
Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier
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Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
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Sulfide __^_ Solids Cyanide Oth sr TOf1
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MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
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Sample Condition On Receipt
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Low Conctjnlidliun
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M90-FTS 55
IMA 8872 bulllaquo PRO^
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Sampling Personnel
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Sample Description copy (Check One) Surface Water
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(J) Shipping Information
Name Of Carrier
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(4) Ship To
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(5) ANALYSIS LAB
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
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Water
0 Shipping Information
Name Of Carrier - - tx
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Airhill Niimhfir bdquo
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LAB FILE COPY
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Transfer Ship To
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
AJexandnc IMA 8874 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION (T) Case Number
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Sampling Personnel Name Of Carrier
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
(5) Sampling Office
Sampling Personnel
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(Phone) Sampling Date
(Begin) (End)
Sample Description copy (Check One) Si irface Wat^r
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Low Concentration
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Water
(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
Sulfide Cyanide
TOC _-_ Fluoride amp pH
LAB FILE COPY
0 Ship To
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0 ANALYSIS LAB if
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Sample Condition On Receipt
(eg broken leakage chain of custody etc ) I
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
SB- ^ INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Sampling Personnel
(Namfil
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(Beoin) (End)
copy Sample Description (Check One)
Surf tiro WatPT f-JronnH W^t^r
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MATCHES ORGANIC SAMPLE NO
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Low CuiiceiilidLiuii
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Water
(e) Shipping Information Name Of Carrier
Datlt=gt Shipped
Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
Sulfade Cyanide
fnr FlnnnHoamppH
LAB FILE COPY
Sample Number
IMA 8876
() Ship To
Attn
Transfer Ship To
0 ANALYSIS LAB
Rlaquov1hy bull mdash f 1 ^ i
DateRfirH
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
- -
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO Bo
IA 8877 INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
(2) SAMPLE CONCENTRATION (Check One)
Low ConceuUdhun
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(e) Shipping Information
Name Of Carrier
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(Beam) (End)
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Airhill Number-
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QC Report No Duplicate SAMPLE MATRIX (Check
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides)
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D nnntion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins bull
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1263 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Water (VOA)
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Soil Sediment
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T rraquoh Sample ID No (Tf Applicable) Medium Concentration
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Matrix Spike Water HSJt ^ Soil Serhrn Pgtn t
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
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Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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QC Report No Hi mlirwta ^ SAMPLE MATRIX
Matrix Spike V 9 7n (Check One)
WQg Water SoilSediment
Df^rTintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1264 ORGANICS TRAFFIC REPORT J) Case Number
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Sample Site NameCode
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0 Shipping Information
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Name of Carrier
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SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration
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C For each sample collected specify number 1of containers used and mark volume level Recd by^ on each bottle hate R^
Sample Condition on Receipt (eg broken nNumber of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
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Sample Location
Mixed Media
Solids
Other (specify)
Special Handling Instructions (eg safety precautions hazardous nature)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
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Preparation
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
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(Begin) (End)
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Airbill Number
Sample Description
Surf ace Water
Ground Water
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SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
Ship To SoilSediment
Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
ice Chain-of-Custody eta) Containers Total Volume
Water i(Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids K
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(To) Special Handling Instructions (eg safety precautions hazardous nature)
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Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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0 Shipping Information
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Name of Carrier
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Airbill Number
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Surface Water
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LowC Concentration Mediu im Concentration
Attn ^gt t r v l xy (f) SAMPLEM ATRIX
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(D For each sample collected sp ecify number (n) AnalysisLab i of containers used and markvolume level FWd Ky ^njc^KcL on each bottle DateRecd- ^^^-^J
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Water -(Extractable)
Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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Case No bull_ V Designate below OC analysis selected Low Concentration
I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
1 f
ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
LowC loncentration Sample Site NameCode Mediu im Concentratic gt SEP 27 1982
Attn K bull - copy SAMPLEM ATRIX
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Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
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Surface Water Mixed Media
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Leachate Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
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Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
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Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
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ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
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Designate below OC analysis selected
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Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
f
ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
S f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
-7 J i bull bull (Name)
(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
Tc i bull i v i Name of Carrier
Date Shipped
t 4 i
Airbill Number
Sample Description
Surf are Water
y Ground Water
Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
(Check One) Transfer
lt Water Cl_- Tgt ^)gt O jf
SoilSi sdiment Ship To Jgt7 nf )f
copy For each sample collected sp ecify number (n) Analysis Lab of containers used and markvolume level RlaquooH hy ^JVj (^5Scdj
on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
| gt i t
Name of Carrier
Date Shipped
--
Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
copy SAMPLE CC gtNCENTRATION 0 Ship To (Cl ieck One)
y LowC loncentration Mediu im Concentration SEP 27 1981
0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
SoilSlt adiment
0 For each sample collected sp ecify number AnalysisLab of containers used and mark volume level on each bottle Date Rflcd- lt poundyenpound
Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull y Ai gt ci V r IK H ij K7 Xvjl l - i l V b)7 2490 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HAQA Nrt ppHsignatfi below QC
T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
tt7 $~poundgt6amp (Phone)
(Begin) (End)
0 Shipping Information
Name of Carrier
asf-z Date Shipped
Airbill Number
reg Sample Description
Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
CvJi^shy
(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullbullbull US ENVIRONMENTAL PROTECTION AGENCY HWISomf BtlaquolH PO Box 8 1 8 Alexandria Virginia 223 13-703 557-2490 FTS 557-2490 mmn ~
iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
r^sgt TSIn noltignfli-ft below QC
I ah Sample in NOanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
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Airbill Number
0 Sample Description
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0 SAMPLE CC 3NCENTRATION (Cl ieck One)
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Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
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Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
I
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
y^ US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number A PO Box 818 AlexandriaVirginia22313-703557-249OFTS 557-2490 is
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
ltc M SVC lt r J
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No - ~- Designate below OC analysis selected Low Concentration
T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
~~| T Ah NATTIlaquo QC REQUIREMENTS SAMPLE CONCENTRATION
(Check One) HARA Nn Designate below QC
analysis performed Low Concentration Lab Sample ID No (Tf Applicable) Medium Concentration
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
jMf^yampH(Phone)
Sampling Date
(Begin) (End)
copy Shipping Information
JfoJWampi fjiampt faZ1
Name of Carrier
Date Shipped
poundC) ~j ltypound
Airbill Number
copy Sample Description
Surface Water
V firoiinH Water
Leachate
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Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office IO I- bullbullbullbull c bullbull Agtxlaquoina Vnyimu22313 703 S57 2490 bullIV1 gt7 2490 Sample Number i ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
(laquoraquo Mr Dfisignate helow QC
T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
y Water
(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Attn
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0 ANALYSIS LAB
Perrj by
DarfiRfirH- ~~
Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
X^ ixxdi= Alexandra VA 22313 703 557 2490 -FTS 5572490 IMA 8870 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION reg Case Number
(Check One) Sample Site NameCode Low ConctJiiUdlion
0 SAMPLE MATRIX (Check One)
J Water
(jj) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
(Phone) - - Dfltfi Shipper Sampling Date
Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
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MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
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INORGANICS TRAFnC REPORT ltT) Case Number gt
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0 SAMPLE CONCENTRATION (Check One)
Low Conctjnlidliun
0 SAMPLE MATRIX (Check One)
mdash Water
(T) Shipping Information Name Of Carrier
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Datp SViipppfi
Airhill Niimher
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_raquopound Task 1 amp 2 Task 3 Ammonia
Sulhde Cyanide
TOC J_- _ FluondeamppH
LAB FILE COPY
(4) Ship To ^ bdquo 4
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0 ANALYSIS LAB
PPI-H -vy r
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No _
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Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check
Matrix Spike __ Water __ SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
(
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides)
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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HaseNo
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(If Applicable) Low Concentration Medium Concentration
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SoilSediment
D nnntion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins bull
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1263 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
(B) Regional Office I Sampling Personnel
(Name)
(Phone)
Sampling Date
(Begin) (End)
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v M - V l ( ^ -raquogt
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Airbill Number
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Surface Water
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Leachate
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SEP 2 7 1982 Attn ^ A (
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on each bottle Date RlaquovH ^ vQ^Roi Sample Condition
Number of Approximate on Receipt (eg broken no Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) J
Water (VOA)
^
Soil Sediment
Water (Ext VOA)
Other
Mixed Media
Solids
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V
lt r M
(D Sample Location
(jo) Special Handling Instructions (eg safety precautions hazardous nature)
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T^hName I QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No - Designate below QC analysis selected Low Conrpmtration
T rraquoh Sample ID No (Tf Applicable) Medium Concentration
QH Report No Di mlirate SAMPLE MATRIX (Check One) - ^
Matrix Spike Water HSJt ^ Soil Serhrn Pgtn t
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
f
f gtfExtractionPreparation(Dioxins)
f
Preparation(VGA)
t
f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Kii8 ORGANICS LABORATORY CHRONICLE (ANALYSIS) HUH
Lh NAme QH REQI IIREMENTS SAMPLE CONCENTRATION (Check One)
naseNrv D^RignatfihelowQC analysis performed Low Concentration
I rah Sample ID No (Tf Applicable) Medium Concentration
QC Report No Hi mlirwta ^ SAMPLE MATRIX
Matrix Spike V 9 7n (Check One)
WQg Water SoilSediment
Df^rTintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1264 ORGANICS TRAFFIC REPORT J) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
(Name) II- - (
(Phone) Sampling Date
(Begin) (End)
0 Shipping Information
A A f
Name of Carrier
Date Shipped
Airbill Number
(s) Sample Description
f Surface Water
ltL- Ground Water
Leachate
SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration
Attn pound SEP 27 SAMPLE MATRIX
(Check One) Transfer
Water SoilSediment Ship To 223
C For each sample collected specify number 1of containers used and mark volume level Recd by^ on each bottle hate R^
Sample Condition on Receipt (eg broken nNumber of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
Special Handling Instructions (eg safety precautions hazardous nature)
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T^hNamJ 1 QC REQUIREMENTS -m -m SAMPLE CONCENTRATION (Check One)
Case No V Designate below OC
T Ah Sample ID Npanalysis selected
(Tf Applicable) Low Concentration Medium Cnnrfiritrfltion
QC Report N^ Hi mliratfi SAMPLE MATRIX (Check One)
Matrix Spike WatorSoilSediment W ^n
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
i
Preparation
(VOA) lt f
shyi iv M-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office -pound Sampling Personnel
(Name) I I bull l t - bull (
(Phone) Sampling Date
(Begin) (End)
(T) Shipping Information
Name of Carrier
Date Shipped
Airbill Number
Sample Description
Surf ace Water
Ground Water
Leachate
SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
Ship To SoilSediment
Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
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Water i(Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids K
Other (specify)
(To) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T ah Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No gt v Designate below OC analysis selected Low Concentration
Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BPH| US ENVIRONMENTAL PROTECnON AGENCY HWISomj iPiimISiigi ORGANICS LABORATORY CHRONICLE (j
mdash| T h Namlaquo i - QC REQUIREMENTS SAMPLE CONCENTRATION
(Check One) Cast Nrgt_ nosignate hfilow QC
analysis performed Low Concentration Lab Sample ID No (Tf Applicable) Medium Concentration
r SAMPLE MATRIX
reg19Q$Matrix Spike Water SoilSediment
D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
j
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office _Z Sampling Personnel
( j JName)
(Phone)
Sampling Date
(Begin) (End)
0 Shipping Information
1 K i t bull (t
Name of Carrier
Date Shipped
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Airbill Number
(|) Sample Description
Surface Water
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T earhate
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LowC Concentration Mediu im Concentration
Attn ^gt t r v l xy (f) SAMPLEM ATRIX
(Check Craquone) v Transfer
Water SoilS sdiment Ship To Lj r ^ )
(D For each sample collected sp ecify number (n) AnalysisLab i of containers used and markvolume level FWd Ky ^njc^KcL on each bottle DateRecd- ^^^-^J
on Receipt (sfj hmkm no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water -(Extractable)
Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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Hl^f ORGANICS LABORATORY CHRONICLE (EXTRACTIONS) HUH i-V
T ah Name f QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No bull_ V Designate below OC analysis selected Low Concentration
I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
1 f
ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
f
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
LowC loncentration Sample Site NameCode Mediu im Concentratic gt SEP 27 1982
Attn K bull - copy SAMPLEM ATRIX
(Check One) Transfer
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copy Regional Office 4- copy For each sample collected sp ecify number copy Analysis Lab j Sainpling Personnel of containers used and mark volume level Rlaquonrl Hy^T) l^^S^lu
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Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
Date Shipped
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Airbill Number
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Surface Water Mixed Media
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Leachate Other (specify)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
Casft No Dp-RirjnatA helow QC analysis performed Low Concentration
Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
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Sampling Date
(Begin) (End)
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Sample Description
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(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
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Attn ltbull v l copy SAMPLEM ATRIX
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on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
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T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
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Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
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(Phone) Sampling Date y i i gt
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Water (VOA) _ j Soil Sediment
Water (ExtVOA)
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Mixed Media
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QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
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Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
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SAMPLE MATRIX (Check One)
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Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
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QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
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(Begin) (End)
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Name of Carrier
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Airbill Number
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( Omiind Water
Leachate
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LowrC Concentration Mediu im Concentration
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
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Airbill Number
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0 SAMPLE CC 3NCENTRATION (Cl ieck One)
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bull Water SouS adiment
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0 For each sample collected sp ecify number (TT) Analynifi LiAb i of containers used and mark volume level pLrl hyy^7-^ltSr flL on each bottle Date R H- 9 -f^^
Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
I
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
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Sampling Date
(Begin) (End)
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(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No - ~- Designate below OC analysis selected Low Concentration
T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
- bull 1 t
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
~~| T Ah NATTIlaquo QC REQUIREMENTS SAMPLE CONCENTRATION
(Check One) HARA Nn Designate below QC
analysis performed Low Concentration Lab Sample ID No (Tf Applicable) Medium Concentration
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
jMf^yampH(Phone)
Sampling Date
(Begin) (End)
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JfoJWampi fjiampt faZ1
Name of Carrier
Date Shipped
poundC) ~j ltypound
Airbill Number
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Surface Water
V firoiinH Water
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
Other (specify)
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office IO I- bullbullbullbull c bullbull Agtxlaquoina Vnyimu22313 703 S57 2490 bullIV1 gt7 2490 Sample Number i ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Name Of Carrier
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LAB FILE COPY
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Sample Condition On Receipt
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Sampling Personnel Name Of Carrier
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MATCHES ORGANIC SAMPLE NO -t-ii
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Condition On Receipt
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D nnntion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins bull
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1263 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
(B) Regional Office I Sampling Personnel
(Name)
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Soil Sediment
Water (Ext VOA)
Other
Mixed Media
Solids
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T^hName I QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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Matrix Spike Water HSJt ^ Soil Serhrn Pgtn t
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
f
f gtfExtractionPreparation(Dioxins)
f
Preparation(VGA)
t
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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QC Report No Hi mlirwta ^ SAMPLE MATRIX
Matrix Spike V 9 7n (Check One)
WQg Water SoilSediment
Df^rTintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1264 ORGANICS TRAFFIC REPORT J) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
(Name) II- - (
(Phone) Sampling Date
(Begin) (End)
0 Shipping Information
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Name of Carrier
Date Shipped
Airbill Number
(s) Sample Description
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Leachate
SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration
Attn pound SEP 27 SAMPLE MATRIX
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C For each sample collected specify number 1of containers used and mark volume level Recd by^ on each bottle hate R^
Sample Condition on Receipt (eg broken nNumber of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
Special Handling Instructions (eg safety precautions hazardous nature)
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Matrix Spike WatorSoilSediment W ^n
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
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Preparation
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office -pound Sampling Personnel
(Name) I I bull l t - bull (
(Phone) Sampling Date
(Begin) (End)
(T) Shipping Information
Name of Carrier
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Airbill Number
Sample Description
Surf ace Water
Ground Water
Leachate
SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
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Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
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(To) Special Handling Instructions (eg safety precautions hazardous nature)
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Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
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ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office _Z Sampling Personnel
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(Phone)
Sampling Date
(Begin) (End)
0 Shipping Information
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Name of Carrier
Date Shipped
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Airbill Number
(|) Sample Description
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T earhate
copy SAMPLE C( DNCENTRATION 0 Ship To (Cl ieck One)
LowC Concentration Mediu im Concentration
Attn ^gt t r v l xy (f) SAMPLEM ATRIX
(Check Craquone) v Transfer
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Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
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ExtractionPreparation T j l
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Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
LowC loncentration Sample Site NameCode Mediu im Concentratic gt SEP 27 1982
Attn K bull - copy SAMPLEM ATRIX
(Check One) Transfer
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Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
Date Shipped
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Airbill Number
reg Sample Description copy Sample Location
Surface Water Mixed Media
firmrnri Water Sohds
Leachate Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
Casft No Dp-RirjnatA helow QC analysis performed Low Concentration
Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
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Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
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(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
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Date Shipped
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Airbill Number
Sample Description
Surf are Water
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Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
(Check One) Transfer
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Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
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(Phone) Sampling Date y i i gt
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Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
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Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
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Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
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(Begin) (End)
0 Shipping Information
Name of Carrier
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Airbill Number
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( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
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Airbill Number
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0 SAMPLE CC 3NCENTRATION (Cl ieck One)
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Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
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0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
ltc M SVC lt r J
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Matrix Spike O t i
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
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(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Attn
Transfer Ship To
0 ANALYSIS LAB
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier
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Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
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Sulfide __^_ Solids Cyanide Oth sr TOf1
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MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
0 Ship To - gt
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Sample Condition On Receipt
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Low Conctjnlidliun
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Sulhde Cyanide
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LAB FILE COPY
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(J) Shipping Information
Name Of Carrier
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Condition On Receipt
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Matrix Spike Water HSJt ^ Soil Serhrn Pgtn t
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
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Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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QC Report No Hi mlirwta ^ SAMPLE MATRIX
Matrix Spike V 9 7n (Check One)
WQg Water SoilSediment
Df^rTintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1264 ORGANICS TRAFFIC REPORT J) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
(Name) II- - (
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0 Shipping Information
A A f
Name of Carrier
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Airbill Number
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Low Concentration Medium Concentration
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C For each sample collected specify number 1of containers used and mark volume level Recd by^ on each bottle hate R^
Sample Condition on Receipt (eg broken nNumber of Approximateice Chain-of-Custody etc) Containers Total Volume
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Water (VOA)
SoilSediment
Water (ExtVOA)
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Sample Location
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Special Handling Instructions (eg safety precautions hazardous nature)
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Matrix Spike WatorSoilSediment W ^n
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
i
Preparation
(VOA) lt f
shyi iv M-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office -pound Sampling Personnel
(Name) I I bull l t - bull (
(Phone) Sampling Date
(Begin) (End)
(T) Shipping Information
Name of Carrier
Date Shipped
Airbill Number
Sample Description
Surf ace Water
Ground Water
Leachate
SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
Ship To SoilSediment
Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
ice Chain-of-Custody eta) Containers Total Volume
Water i(Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids K
Other (specify)
(To) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull bull A p bull bull bull bull bull -CJ IW bull TI 7 M9U Sample Number
ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T ah Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No gt v Designate below OC analysis selected Low Concentration
Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
^ t
Preparation -^ (VGA) f i
f f+V- r ttfs r
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BPH| US ENVIRONMENTAL PROTECnON AGENCY HWISomj iPiimISiigi ORGANICS LABORATORY CHRONICLE (j
mdash| T h Namlaquo i - QC REQUIREMENTS SAMPLE CONCENTRATION
(Check One) Cast Nrgt_ nosignate hfilow QC
analysis performed Low Concentration Lab Sample ID No (Tf Applicable) Medium Concentration
r SAMPLE MATRIX
reg19Q$Matrix Spike Water SoilSediment
D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
j
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office _Z Sampling Personnel
( j JName)
(Phone)
Sampling Date
(Begin) (End)
0 Shipping Information
1 K i t bull (t
Name of Carrier
Date Shipped
j i
Airbill Number
(|) Sample Description
Surface Water
y Ground Water
T earhate
copy SAMPLE C( DNCENTRATION 0 Ship To (Cl ieck One)
LowC Concentration Mediu im Concentration
Attn ^gt t r v l xy (f) SAMPLEM ATRIX
(Check Craquone) v Transfer
Water SoilS sdiment Ship To Lj r ^ )
(D For each sample collected sp ecify number (n) AnalysisLab i of containers used and markvolume level FWd Ky ^njc^KcL on each bottle DateRecd- ^^^-^J
on Receipt (sfj hmkm no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water -(Extractable)
Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
(jo) Special Handling Instructions (e g safety precautions hazardous nature)
i
i BB US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^ bullbullbullbullbullptrade
Hl^f ORGANICS LABORATORY CHRONICLE (EXTRACTIONS) HUH i-V
T ah Name f QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No bull_ V Designate below OC analysis selected Low Concentration
I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
1 f
ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
f
f sOti i
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
LowC loncentration Sample Site NameCode Mediu im Concentratic gt SEP 27 1982
Attn K bull - copy SAMPLEM ATRIX
(Check One) Transfer
^L Water SoiVS sdiment ShipTo $J(0
copy Regional Office 4- copy For each sample collected sp ecify number copy Analysis Lab j Sainpling Personnel of containers used and mark volume level Rlaquonrl Hy^T) l^^S^lu
on each bottle Date R^rl-^-jfD^^ L bull ^ ( Sample Condition
(Name) Approximate On Receipt (eg broken no 1 Number of
i bull - Containers Total Volume ice Chain-of-Custody etc)
(Phone) Water j 1 bull Sampling Date (Extractable) gt bull Water
J (Begin) (End) (VOA) v
Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
Date Shipped
h
Airbill Number
reg Sample Description copy Sample Location
Surface Water Mixed Media
firmrnri Water Sohds
Leachate Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
1
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office PC rxvcHht Vxin-n t V i ru in i Z3 i i 703 ^77490-ITo SIv90 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
i bullbull
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullB l US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^KpHHRjllMg
KM^ OHGANICS LABORATORY CHRONICLE (ANALYSIS) ^H^^l ^Ht^^^ijB bull
Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
Casft No Dp-RirjnatA helow QC analysis performed Low Concentration
Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
f
ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
S f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
-7 J i bull bull (Name)
(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
Tc i bull i v i Name of Carrier
Date Shipped
t 4 i
Airbill Number
Sample Description
Surf are Water
y Ground Water
Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
(Check One) Transfer
lt Water Cl_- Tgt ^)gt O jf
SoilSi sdiment Ship To Jgt7 nf )f
copy For each sample collected sp ecify number (n) Analysis Lab of containers used and markvolume level RlaquooH hy ^JVj (^5Scdj
on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
iB^ffi US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^BpBlaquoraquoiippM
KiBJgll ORGANTCS LABORATORY CHRONICLE (EXTRACTIONS) ^jjjjjlj^
I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
| gt i t
Name of Carrier
Date Shipped
--
Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
copy SAMPLE CC gtNCENTRATION 0 Ship To (Cl ieck One)
y LowC loncentration Mediu im Concentration SEP 27 1981
0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
SoilSlt adiment
0 For each sample collected sp ecify number AnalysisLab of containers used and mark volume level on each bottle Date Rflcd- lt poundyenpound
Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull y Ai gt ci V r IK H ij K7 Xvjl l - i l V b)7 2490 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HAQA Nrt ppHsignatfi below QC
T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
bullV
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
T flb Sample TD Nn
Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
tt7 $~poundgt6amp (Phone)
(Begin) (End)
0 Shipping Information
Name of Carrier
asf-z Date Shipped
Airbill Number
reg Sample Description
Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
CvJi^shy
(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullbullbull US ENVIRONMENTAL PROTECTION AGENCY HWISomf BtlaquolH PO Box 8 1 8 Alexandria Virginia 223 13-703 557-2490 FTS 557-2490 mmn ~
iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
r^sgt TSIn noltignfli-ft below QC
I ah Sample in NOanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
bull7 o gt z Date Snipped
Airbill Number
0 Sample Description
Surface Water bull Ground Water
Learhate
0 SAMPLE CC 3NCENTRATION (Cl ieck One)
LowC Concentration Mediu m Concentration
0 SAMPLE MATRIX (Check Otae) t
bull Water SouS adiment
^^ A
0 For each sample collected sp ecify number (TT) Analynifi LiAb i of containers used and mark volume level pLrl hyy^7-^ltSr flL on each bottle Date R H- 9 -f^^
Sample Condittom on Receipt (eg broken nc Number of Approximate
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Mixed Media
Solids
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Ship To If ft f
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Designate below QC analysis performed
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Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
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Sample Site NameCode
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(3) SAMPLE MATRIX (Check One)
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For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
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Water (VGA)
SoilSediment
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Name of Carrier Other
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Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Name Of Carrier s
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LAB FILE COPY
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
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Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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I rah Sample ID No (Tf Applicable) Medium Concentration
QC Report No Hi mlirwta ^ SAMPLE MATRIX
Matrix Spike V 9 7n (Check One)
WQg Water SoilSediment
Df^rTintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1264 ORGANICS TRAFFIC REPORT J) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
(Name) II- - (
(Phone) Sampling Date
(Begin) (End)
0 Shipping Information
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Name of Carrier
Date Shipped
Airbill Number
(s) Sample Description
f Surface Water
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Leachate
SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration
Attn pound SEP 27 SAMPLE MATRIX
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C For each sample collected specify number 1of containers used and mark volume level Recd by^ on each bottle hate R^
Sample Condition on Receipt (eg broken nNumber of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
Special Handling Instructions (eg safety precautions hazardous nature)
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QC Report N^ Hi mliratfi SAMPLE MATRIX (Check One)
Matrix Spike WatorSoilSediment W ^n
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
i
Preparation
(VOA) lt f
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office -pound Sampling Personnel
(Name) I I bull l t - bull (
(Phone) Sampling Date
(Begin) (End)
(T) Shipping Information
Name of Carrier
Date Shipped
Airbill Number
Sample Description
Surf ace Water
Ground Water
Leachate
SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
Ship To SoilSediment
Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
ice Chain-of-Custody eta) Containers Total Volume
Water i(Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids K
Other (specify)
(To) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T ah Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No gt v Designate below OC analysis selected Low Concentration
Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office _Z Sampling Personnel
( j JName)
(Phone)
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0 Shipping Information
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Name of Carrier
Date Shipped
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Airbill Number
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Surface Water
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LowC Concentration Mediu im Concentration
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Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
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(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
1 f
ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
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Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
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Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
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Low Concentration Medium Concentration
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Matrix Spike Water laquoN Oi2
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Water (VOA)
SoilSediment
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Other
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Mixed Media
Solids
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T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
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Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
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Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
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Mixed Media
Solid
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Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Matrix Spike tty n (Check One)
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
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SAMPLE MATRIX (Check One)
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Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
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QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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LowrC Concentration Mediu im Concentration
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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Water (Extractable) f
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SoilSediment
Water (ExtVOA)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
r^sgt TSIn noltignfli-ft below QC
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
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Airbill Number
0 Sample Description
Surface Water bull Ground Water
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0 SAMPLE CC 3NCENTRATION (Cl ieck One)
LowC Concentration Mediu m Concentration
0 SAMPLE MATRIX (Check Otae) t
bull Water SouS adiment
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0 For each sample collected sp ecify number (TT) Analynifi LiAb i of containers used and mark volume level pLrl hyy^7-^ltSr flL on each bottle Date R H- 9 -f^^
Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
ltc M SVC lt r J
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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analysis performed Low Concentration Lab Sample ID No (Tf Applicable) Medium Concentration
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
jMf^yampH(Phone)
Sampling Date
(Begin) (End)
copy Shipping Information
JfoJWampi fjiampt faZ1
Name of Carrier
Date Shipped
poundC) ~j ltypound
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copy Sample Description
Surface Water
V firoiinH Water
Leachate
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copy For each sample collected sp ecify number (n) AnalysisLab bullbull of containers used and mark volume level on each bottle Date RACU- 7^5SJ
ij|fimT3ft ^^oncntioii on Receipt (eg broken ac Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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Case No Designate below OC analysis selected Low Concentration
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QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Attn
Transfer Ship To
0 ANALYSIS LAB
Perrj by
DarfiRfirH- ~~
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier
(Name)
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Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
Task 3 Ammonia
Sulfide __^_ Solids Cyanide Oth sr TOf1
(specify) ^_ Fluoride amp pH
MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
0 Ship To - gt
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Transfer Ship To
0 ANALYSIS LAB
Rerrt hy ^
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Sample Condition On Receipt
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INORGANICS TRAFnC REPORT ltT) Case Number gt
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Sample Description copy (Check One) bdquo Surface Water
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____ Solids nth^r
(specify) MATCHES ORGANIC SAMPLE NOshy
0 SAMPLE CONCENTRATION (Check One)
Low Conctjnlidliun
0 SAMPLE MATRIX (Check One)
mdash Water
(T) Shipping Information Name Of Carrier
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Datp SViipppfi
Airhill Niimher
0 Mark Volume Level On Sample Bottle Check Analysis required
_raquopound Task 1 amp 2 Task 3 Ammonia
Sulhde Cyanide
TOC J_- _ FluondeamppH
LAB FILE COPY
(4) Ship To ^ bdquo 4
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0 ANALYSIS LAB
PPI-H -vy r
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Sample Condition On Receipt
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Sample Site NameCode
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Sampling Personnel
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Sample Description copy (Check One) Surface Water
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MATCHES ORGANIC SAMPLE NOmdashimdash mdashgtshy
SAMPLE CONCENTRATION (Check One) mdash Low Concentration
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(J) Shipping Information
Name Of Carrier
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(a) Mark Volume Level On Sample Bottle Check Analysis required
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Sulfide Cyanide
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(4) Ship To
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Transfer Ship To
(5) ANALYSIS LAB
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Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
Sample Site NameCode
(cpound) Samplina Office
Sampling Personnel
(Name-)
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Sample Description copy (Check One) bdquo Surface Water
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0 Shipping Information
Name Of Carrier - - tx
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Airhill Niimhfir bdquo
(J) Mark Volume Level On Sample Bottle Check Analysis required
_ Task 1 amp 2 Task 3 Ammonia
Sulfide Cyanide
TOC T - - Fluoride amp pH
LAB FILE COPY
0 Ship To ft
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Transfer Ship To
0 ANALYSIS LAB
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Sample Condition On Receipt
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J -1
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
AJexandnc IMA 8874 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION (T) Case Number
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Sampling Personnel Name Of Carrier
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Sampling Date Airhll Niimhpsr
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Sample Description (a) Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required GSronnd Water
Ta=lr 1 K
Taslf S Ammonia
Sulfide Solids Cyanide OtVmr
TOC (specify) f ^ - - Fluoride amp pH MATCHES ORGANIC SAMPI K MO 1
LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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Sampling Personnel
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(Phone) Sampling Date
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Sample Description copy (Check One) Si irface Wat^r
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(specify) MATCHES ORGANIC S AMPT K NO
0 SAMPLE CONCENTRATION (Check One)
Low Concentration
0 SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
Sulfide Cyanide
TOC _-_ Fluoride amp pH
LAB FILE COPY
0 Ship To
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0 ANALYSIS LAB if
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Sample Condition On Receipt
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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Sample Site NameCode
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0 SAMPLE MATRIX (Check One)
Water
(e) Shipping Information Name Of Carrier
Datlt=gt Shipped
Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
Sulfade Cyanide
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LAB FILE COPY
Sample Number
IMA 8876
() Ship To
Attn
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0 ANALYSIS LAB
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO Bo
IA 8877 INORGANICS TRAFFIC REPORT reg Case Number
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Name Of Carrier
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_____ Solids Oth mshy
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Task 1 amp 2 Task 3 Ammnnifl
Sulfide Cyanide
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LAB FILE COPY
(T) Ship To
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RwH Vy f i
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(eg broken leakage chain of custody etc )
bull bull - raquo bull
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
rub^vcU Alexandria VA22313 703 557-2490-FTS 5572490 IMA SSTS PRddeg INORGANICS TRAFHC REPORT
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Water _ SoilSedimpnt
(5) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
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Airbill MiimhfiTshy
(Becrin) (End)
Sample Description (J) Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required fiTrgtunH Watdegr
Task 1 amp 2 Task 3 Ammnnia
Sulfide Solids Cyanide nthfir
TOG (specify) FliirHlaquo pH
MATPHRS ORGANIC SAMPIR MO --
LAB FILE COPY
0 Ship To
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Rpr-H hy - ltbull bull I
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office PO Bo
INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION reg Case Number
(Check One) Sample Site NameCode Luw Cuiicenlidliou
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(5) Sampling Office lt (e) Shipping Information
Sampling Personnel Name Of Carrier
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Sampling Date Airhill Niimhfir
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Surfflrp Wator Check Analysis required f mdash Ground Water
Task 1 amp 2 Tank 3 Ammonia
Sulhde Solids Cyanide Other Tor (specify)
_ FtiirH^pH MATCHES ORGANIC S AMPT R NO _
LAB FILE COPY
(4) Ship To - 1 A
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Attn
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(9) ANALYSIS LAB
Rlaquorrl Vy - gt ^
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(fo) C 1 f --raquoraquo-
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
reg Case Number Sample Site NameCode
(jj) Sampling Office
Sampling Personnel
(Name) -
(Phone) Sampling Date
(Beam) (End)
Sample Description copy (Check One) Surface Water OiroTinH Writer
_____ Solids OHi(=r
(specify) MATCHES ORGANIC SAMPLK MO
SAMPLE CONCENTRATION (Check One)
Low CunceutidLiou
0 SAMPLE MATRIX (Check One)
Water SoilSedirnpnt
(e) Shipping Information
Name Of Carrier s
lt- i
DatR SViipppr)
Airhill Niimhfir
(s) Mark Volume Level On Sample Bottle Check Analysis required
i_ Task 1 amp 2 Tsslf 3 Ammonia
Sulfide Cyanide
TOC Fl^^nHo laquor pH
LAB FILE COPY
(T) Ship To
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Attnx i f r - ^ f lt Transfer Ship To
reg ANALYSIS LAB
R^Hhy - ^
natfiRp-rrl lt ^ ^
Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Sampling Personnel
(Nflmp)
(Phone) Sampling Date
(Begin) (End)
copy Sample Description (Check One)
M Surface Water _ (Ground Wfltpt
Solids Othmshy
(specify)
MATCHES ORGANIC SAMPLE NO
SAMPLE CONCENTRATION (Check One)
Low Concentration
reg SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier f t flt f raquo - f
Dfltp Shipped
Airbil l NiimhRr
(a) Mark Volume Level On Sample Bottle Check Analysis required
^ Task 1 amp 2 _ Task 3 Ammnma
Sulfide Cyanide
TOG Jmdash- Fluoride amp pH
LAB FILE COPY
0 Ship To
-
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Attn^ gt i lt- lt
Transfer Ship To
() ANALYSIS LAB
R0H hy f
DatfiRflcH i
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
v
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
(j Satnplina Office
Sampling Personnel
(Name) -
(Phone) Sampling Date
(Begin) (End) J shy
Sample Description copy (Check One) Surface Water
mdash jmdash Ground Water
Solids Othpr
(specify) MATCHES ORGANIC S AMPI K NO
SAMPLE CONCENTRATION (Check One)
mdash Low Concentration
(5) SAMPLE MATRIX (Check One)
f Water
() Shipping Information
Name Of Carrier
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D^tfi RViippesfi t
Airhill Number
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_L Task 1 amp 2 Task 3 Ammonia
Sulfide Cyanide
Tnr raquo__ FlnrHlaquo amp pH
LAB FILE COPY
(5) Ship To v^1 A
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Attn
Transfer Ship To
() ANALYSIS LAB
TD u raquo A r lt pprrl hy
DateRttrH
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
f
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
SSJ IA 8883 INORGANICS TRAFnC REPORT 0 SAMPLE CONCENTRATION (T) Case Number _ bdquo 0 Ship To shy
(Check One) Sample Site NameCode f mdash Low Concentration ^
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Transfer Ship To
(5) Sampling Office 0 Shipping Information 0 ANALYSIS LAB
Sampling Personnel Name Of Carrier it
Ror-H Ky - -
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Sampling Date Airlr1 Niirphfir shy
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Sample Condition On Receipt Sample Description (^ Mark Volume Level copy (Check One) On Sample Bottle (eg broken leakage chain of custody etc )
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Df^rTintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1264 ORGANICS TRAFFIC REPORT J) Case Number
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Sample Site NameCode
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Water (VOA)
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Mixed Media
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Special Handling Instructions (eg safety precautions hazardous nature)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
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Preparation
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
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Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
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Surf ace Water
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Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
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Transfer 1 Water
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Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
ice Chain-of-Custody eta) Containers Total Volume
Water i(Extractable)
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(To) Special Handling Instructions (eg safety precautions hazardous nature)
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Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
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(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
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ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
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Matrix Spike Water
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Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
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(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
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Airbill Number
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Surf ace Water
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(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
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Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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Case No
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
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Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
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Low Concentration Medium Concentration
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Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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Matrix Spike QV ft n (Check One)
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Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
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Mixed Media
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Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
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Date Snipped
Airbill Number
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For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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Other (specify)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
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(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
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Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
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Water (ExtVOA)
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Mixed Media
Solids
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Ship To If ft f
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(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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Iflb Sample ID No
Designate below OC analysis selected
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ExtractionPreparation (Acid)
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Low Concentration Medium Concentration
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Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
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Name of Carrier Other
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(10) Special Handling Instructions (e g safety precautions hazardous nature)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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Name Of Carrier
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Condition On Receipt
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LAB FILE COPY
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KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
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Low CunceutidLiou
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Water SoilSedirnpnt
(e) Shipping Information
Name Of Carrier s
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Airhill Niimhfir
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Sulfide Cyanide
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LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
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Low Concentration
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LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
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(Begin) (End) J shy
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LAB FILE COPY
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MATCHES ORGANIC SAMPLE NO
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1264 ORGANICS TRAFFIC REPORT J) Case Number
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Sample Site NameCode
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
i
Preparation
(VOA) lt f
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office -pound Sampling Personnel
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(Phone) Sampling Date
(Begin) (End)
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Name of Carrier
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Sample Description
Surf ace Water
Ground Water
Leachate
SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
Ship To SoilSediment
Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
ice Chain-of-Custody eta) Containers Total Volume
Water i(Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
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Sample Location
Mixed Media
Solids K
Other (specify)
(To) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T ah Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No gt v Designate below OC analysis selected Low Concentration
Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
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Name of Carrier
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LowC Concentration Mediu im Concentration
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Water (VOA) shy
SoilSediment
Water (ExtVOA)
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Mixed Media
Solids
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(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
1 f
ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
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SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
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SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
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Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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(Begin) (End)
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Water (VOA)
SoilSediment
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Other
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Mixed Media
Solids
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Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
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(Phone) Sampling Date y i i gt
(Begin) (End)
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Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
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Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
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Mixed Media
Solid
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
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SAMPLE MATRIX (Check One)
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Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
bullV
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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(Begin) (End)
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Airbill Number
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Leachate
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LowrC Concentration Mediu im Concentration
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
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Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
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(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
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Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
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Water (ExtVOA)
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Mixed Media
Solids
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Ship To If ft f
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(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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Iflb Sample ID No
Designate below OC analysis selected
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ExtractionPreparation (Acid)
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Low Concentration Medium Concentration
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Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
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Name of Carrier Other
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(10) Special Handling Instructions (e g safety precautions hazardous nature)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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Name Of Carrier
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Condition On Receipt
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LAB FILE COPY
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KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
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Low CunceutidLiou
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Water SoilSedirnpnt
(e) Shipping Information
Name Of Carrier s
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Airhill Niimhfir
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Sulfide Cyanide
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LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
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Low Concentration
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LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
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(Begin) (End) J shy
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LAB FILE COPY
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TD u raquo A r lt pprrl hy
DateRttrH
Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
SSJ IA 8883 INORGANICS TRAFnC REPORT 0 SAMPLE CONCENTRATION (T) Case Number _ bdquo 0 Ship To shy
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Sampling Personnel Name Of Carrier it
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Tflsk 3 Ammonia Sulfide Solids
OtW Cyanide
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MATCHES ORGANIC SAMPLE NO
LAB FILE COPY
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QC Report N^ Hi mliratfi SAMPLE MATRIX (Check One)
Matrix Spike WatorSoilSediment W ^n
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
ExtractionPreparation (Dioxins)
i
Preparation
(VOA) lt f
shyi iv M-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office -pound Sampling Personnel
(Name) I I bull l t - bull (
(Phone) Sampling Date
(Begin) (End)
(T) Shipping Information
Name of Carrier
Date Shipped
Airbill Number
Sample Description
Surf ace Water
Ground Water
Leachate
SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
Ship To SoilSediment
Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
ice Chain-of-Custody eta) Containers Total Volume
Water i(Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids K
Other (specify)
(To) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T ah Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No gt v Designate below OC analysis selected Low Concentration
Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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reg19Q$Matrix Spike Water SoilSediment
D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
j
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office _Z Sampling Personnel
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(Phone)
Sampling Date
(Begin) (End)
0 Shipping Information
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Name of Carrier
Date Shipped
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Airbill Number
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Surface Water
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T earhate
copy SAMPLE C( DNCENTRATION 0 Ship To (Cl ieck One)
LowC Concentration Mediu im Concentration
Attn ^gt t r v l xy (f) SAMPLEM ATRIX
(Check Craquone) v Transfer
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Water -(Extractable)
Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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Case No bull_ V Designate below OC analysis selected Low Concentration
I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
1 f
ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
LowC loncentration Sample Site NameCode Mediu im Concentratic gt SEP 27 1982
Attn K bull - copy SAMPLEM ATRIX
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(Name) Approximate On Receipt (eg broken no 1 Number of
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(Phone) Water j 1 bull Sampling Date (Extractable) gt bull Water
J (Begin) (End) (VOA) v
Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
Date Shipped
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Airbill Number
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Surface Water Mixed Media
firmrnri Water Sohds
Leachate Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
1
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
i bullbull
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
Casft No Dp-RirjnatA helow QC analysis performed Low Concentration
Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
f
ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
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(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
Tc i bull i v i Name of Carrier
Date Shipped
t 4 i
Airbill Number
Sample Description
Surf are Water
y Ground Water
Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
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on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
| gt i t
Name of Carrier
Date Shipped
--
Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
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0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
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Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull y Ai gt ci V r IK H ij K7 Xvjl l - i l V b)7 2490 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
bullV
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
tt7 $~poundgt6amp (Phone)
(Begin) (End)
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Name of Carrier
asf-z Date Shipped
Airbill Number
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Surf are Water
( Omiind Water
Leachate
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LowrC Concentration Mediu im Concentration
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
CvJi^shy
(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
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(Phone) Sampling Date 7v 7^7 f^c^
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Mixed Media
Solids
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Ship To If ft f
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(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
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Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
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Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
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Name of Carrier Other
-t-f-Date Shipped
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copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
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Water (VOA) 2 ^lt
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Mixed Media
Solids
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QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Name Of Carrier
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(e) Shipping Information
Name Of Carrier
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Airbill NiimhfiT
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Task 1 amp 2 Task 3 Ammonia
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
rub^vcU Alexandria VA22313 703 557-2490-FTS 5572490 IMA SSTS PRddeg INORGANICS TRAFHC REPORT
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KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
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Airhill Niimhfir
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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LAB FILE COPY
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number IO Rox8i8 AIexltir1riu Virginia 22313 703557 2490 ITS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
Lab Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case Nomdash
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Designate below QC analysis performed
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QC Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike nWater deg 9 ty SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
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(Phone) Sampling Date
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Surf ace Water
Ground Water
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SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
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Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
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ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T ah Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
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ExtractionPreparation T j l
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Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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Designate below QC analysis performed
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Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
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Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
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(Phone)
Sampling Date
(Begin) (End)
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Airbill Number
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Surf ace Water
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(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
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Water (Extractable)
Water (VOA)
SoilSediment
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Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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Case No
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Designate below OC analysis selected
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ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Low Concentration Medium Concentration
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Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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Matrix Spike QV ft n (Check One)
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Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
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Mixed Media
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Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
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For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
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Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Water (Extractable) f
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SoilSediment
Water (ExtVOA)
Other
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
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(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
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Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
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Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
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Sampling Date
(Begin) (End)
copy Shipping Information
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Name of Carrier
Date Shipped
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copy Sample Description
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
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copy Special Handling Instructions (eg safety precautions hazardous nature)
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QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
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Datp Rhippfirf-
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(B) Mark Volume Level On Sample Bottle Check Analysis required
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Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Attn
Transfer Ship To
0 ANALYSIS LAB
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier
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Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
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MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
0 Ship To - gt
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Transfer Ship To
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Rerrt hy ^
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Sample Condition On Receipt
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Low Conctjnlidliun
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Sulhde Cyanide
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LAB FILE COPY
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Sample Condition On Receipt
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Name Of Carrier
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Sulfide Cyanide
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
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LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier
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Sulfide Solids Cyanide OtVmr
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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(Phone) Sampling Date
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Sample Description copy (Check One) Si irface Wat^r
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Low Concentration
0 SAMPLE MATRIX (Check One)
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(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
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TOC _-_ Fluoride amp pH
LAB FILE COPY
0 Ship To
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Sample Condition On Receipt
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
Sulfade Cyanide
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LAB FILE COPY
Sample Number
IMA 8876
() Ship To
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Task 1 amp 2 Task 3 Ammnnifl
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier
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Airbill MiimhfiTshy
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Sample Condition On Receipt
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Sulhde Solids Cyanide Other Tor (specify)
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LAB FILE COPY
(4) Ship To - 1 A
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(9) ANALYSIS LAB
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
reg Case Number Sample Site NameCode
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Sampling Personnel
(Name) -
(Phone) Sampling Date
(Beam) (End)
Sample Description copy (Check One) Surface Water OiroTinH Writer
_____ Solids OHi(=r
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SAMPLE CONCENTRATION (Check One)
Low CunceutidLiou
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Water SoilSedirnpnt
(e) Shipping Information
Name Of Carrier s
lt- i
DatR SViipppr)
Airhill Niimhfir
(s) Mark Volume Level On Sample Bottle Check Analysis required
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Sulfide Cyanide
TOC Fl^^nHo laquor pH
LAB FILE COPY
(T) Ship To
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Low Concentration
reg SAMPLE MATRIX (Check One)
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(e) Shipping Information
Name Of Carrier f t flt f raquo - f
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LAB FILE COPY
0 Ship To
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R0H hy f
DatfiRflcH i
Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
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(5) SAMPLE MATRIX (Check One)
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Name Of Carrier
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LAB FILE COPY
(5) Ship To v^1 A
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Transfer Ship To
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TD u raquo A r lt pprrl hy
DateRttrH
Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
SSJ IA 8883 INORGANICS TRAFnC REPORT 0 SAMPLE CONCENTRATION (T) Case Number _ bdquo 0 Ship To shy
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Sampling Personnel Name Of Carrier it
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Burfarp Water Check Analysis required laquo GifounH Wfltpr - lt - Cs_i_ Task 1 amp 2
Tflsk 3 Ammonia Sulfide Solids
OtW Cyanide
TOC (specify) L - Fluoride amp pH
MATCHES ORGANIC SAMPLE NO
LAB FILE COPY
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1265 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office -pound Sampling Personnel
(Name) I I bull l t - bull (
(Phone) Sampling Date
(Begin) (End)
(T) Shipping Information
Name of Carrier
Date Shipped
Airbill Number
Sample Description
Surf ace Water
Ground Water
Leachate
SAMPLE CONCENTRATION (pound) Ship To (Check One)
Low Concentration Medium Concentration
SEP 2 7 1981 Attn i
SAMPLE MATRIX (Check One)
Transfer 1 Water
Ship To SoilSediment
Por each sample collected specify number 1(0) AnalyBfflj[ ab of containers used and mark volume level Rec on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nc
ice Chain-of-Custody eta) Containers Total Volume
Water i(Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids K
Other (specify)
(To) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull bull A p bull bull bull bull bull -CJ IW bull TI 7 M9U Sample Number
ORGAN1CS LABORATORY CHRONICLE (EXTRACTIONS)
T ah Name QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No gt v Designate below OC analysis selected Low Concentration
Lab Sample ID No (If Applicable) Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX (Check One)
Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) lt
ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
f f+V- r ttfs r
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office _Z Sampling Personnel
( j JName)
(Phone)
Sampling Date
(Begin) (End)
0 Shipping Information
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Name of Carrier
Date Shipped
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Airbill Number
(|) Sample Description
Surface Water
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T earhate
copy SAMPLE C( DNCENTRATION 0 Ship To (Cl ieck One)
LowC Concentration Mediu im Concentration
Attn ^gt t r v l xy (f) SAMPLEM ATRIX
(Check Craquone) v Transfer
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Water -(Extractable)
Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
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ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
LowC loncentration Sample Site NameCode Mediu im Concentratic gt SEP 27 1982
Attn K bull - copy SAMPLEM ATRIX
(Check One) Transfer
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copy Regional Office 4- copy For each sample collected sp ecify number copy Analysis Lab j Sainpling Personnel of containers used and mark volume level Rlaquonrl Hy^T) l^^S^lu
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(Phone) Water j 1 bull Sampling Date (Extractable) gt bull Water
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Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
Date Shipped
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Airbill Number
reg Sample Description copy Sample Location
Surface Water Mixed Media
firmrnri Water Sohds
Leachate Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
Casft No Dp-RirjnatA helow QC analysis performed Low Concentration
Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
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(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
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Airbill Number
Sample Description
Surf are Water
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Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
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Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
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(Phone) Sampling Date y i i gt
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0 Shipping Information
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Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
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Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
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Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
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(Begin) (End)
0 Shipping Information
Name of Carrier
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Airbill Number
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Leachate
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LowrC Concentration Mediu im Concentration
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
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Airbill Number
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0 SAMPLE CC 3NCENTRATION (Cl ieck One)
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Sample Condittom on Receipt (eg broken nc Number of Approximate
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Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
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0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
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Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
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Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
ltc M SVC lt r J
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Acid
Pesticides
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Matrix Spike Water WN 01laquo SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
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ExtractionPreparation (Acid)
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ExtractionPreparation (Dioxins) bull
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Preparation -^ (VGA) f i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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0 Shipping Information
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Name of Carrier
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(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
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ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
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SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
LowC loncentration Sample Site NameCode Mediu im Concentratic gt SEP 27 1982
Attn K bull - copy SAMPLEM ATRIX
(Check One) Transfer
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copy Regional Office 4- copy For each sample collected sp ecify number copy Analysis Lab j Sainpling Personnel of containers used and mark volume level Rlaquonrl Hy^T) l^^S^lu
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Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
Date Shipped
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Airbill Number
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Surface Water Mixed Media
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Leachate Other (specify)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
Casft No Dp-RirjnatA helow QC analysis performed Low Concentration
Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
f
ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
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(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
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Airbill Number
Sample Description
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(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
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on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
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Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
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Water (VOA) _ j Soil Sediment
Water (ExtVOA)
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Mixed Media
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I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
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Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
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(Begin) (End)
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Name of Carrier
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Airbill Number
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( Omiind Water
Leachate
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LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
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Airbill Number
0 Sample Description
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0 SAMPLE CC 3NCENTRATION (Cl ieck One)
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bull Water SouS adiment
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0 For each sample collected sp ecify number (TT) Analynifi LiAb i of containers used and mark volume level pLrl hyy^7-^ltSr flL on each bottle Date R H- 9 -f^^
Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
I
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
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(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No - ~- Designate below OC analysis selected Low Concentration
T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
- bull 1 t
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
~~| T Ah NATTIlaquo QC REQUIREMENTS SAMPLE CONCENTRATION
(Check One) HARA Nn Designate below QC
analysis performed Low Concentration Lab Sample ID No (Tf Applicable) Medium Concentration
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
jMf^yampH(Phone)
Sampling Date
(Begin) (End)
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JfoJWampi fjiampt faZ1
Name of Carrier
Date Shipped
poundC) ~j ltypound
Airbill Number
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Surface Water
V firoiinH Water
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copy SAMPLE C( DNCENTRATION copy Ship To Of bull tlt (Cl leckOne) bullgtbull V C( ty finlt- ty
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
Other (specify)
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office IO I- bullbullbullbull c bullbull Agtxlaquoina Vnyimu22313 703 S57 2490 bullIV1 gt7 2490 Sample Number i ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Name Of Carrier
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Condition On Receipt
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(J) Mark Volume Level On Sample Bottle Check Analysis required
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Sample Condition On Receipt
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D^a^rrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Name of Carrier
Date Shipped
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LowC Concentration Mediu im Concentration
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Water -(Extractable)
Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
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ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
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SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
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Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
Date Shipped
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Airbill Number
reg Sample Description copy Sample Location
Surface Water Mixed Media
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Leachate Other (specify)
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T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
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Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
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amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
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Designate below OC analysis selected
(Tf Applicable)
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Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
S f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
-7 J i bull bull (Name)
(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
Tc i bull i v i Name of Carrier
Date Shipped
t 4 i
Airbill Number
Sample Description
Surf are Water
y Ground Water
Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
(Check One) Transfer
lt Water Cl_- Tgt ^)gt O jf
SoilSi sdiment Ship To Jgt7 nf )f
copy For each sample collected sp ecify number (n) Analysis Lab of containers used and markvolume level RlaquooH hy ^JVj (^5Scdj
on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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KiBJgll ORGANTCS LABORATORY CHRONICLE (EXTRACTIONS) ^jjjjjlj^
I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
| gt i t
Name of Carrier
Date Shipped
--
Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
copy SAMPLE CC gtNCENTRATION 0 Ship To (Cl ieck One)
y LowC loncentration Mediu im Concentration SEP 27 1981
0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
SoilSlt adiment
0 For each sample collected sp ecify number AnalysisLab of containers used and mark volume level on each bottle Date Rflcd- lt poundyenpound
Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull y Ai gt ci V r IK H ij K7 Xvjl l - i l V b)7 2490 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HAQA Nrt ppHsignatfi below QC
T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
T flb Sample TD Nn
Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
tt7 $~poundgt6amp (Phone)
(Begin) (End)
0 Shipping Information
Name of Carrier
asf-z Date Shipped
Airbill Number
reg Sample Description
Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
CvJi^shy
(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullbullbull US ENVIRONMENTAL PROTECTION AGENCY HWISomf BtlaquolH PO Box 8 1 8 Alexandria Virginia 223 13-703 557-2490 FTS 557-2490 mmn ~
iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
r^sgt TSIn noltignfli-ft below QC
I ah Sample in NOanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
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Airbill Number
0 Sample Description
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Learhate
0 SAMPLE CC 3NCENTRATION (Cl ieck One)
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0 SAMPLE MATRIX (Check Otae) t
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0 For each sample collected sp ecify number (TT) Analynifi LiAb i of containers used and mark volume level pLrl hyy^7-^ltSr flL on each bottle Date R H- 9 -f^^
Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
ltc M SVC lt r J
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
bullH l US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^^gmmimfim
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No - ~- Designate below OC analysis selected Low Concentration
T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
~~| T Ah NATTIlaquo QC REQUIREMENTS SAMPLE CONCENTRATION
(Check One) HARA Nn Designate below QC
analysis performed Low Concentration Lab Sample ID No (Tf Applicable) Medium Concentration
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
jMf^yampH(Phone)
Sampling Date
(Begin) (End)
copy Shipping Information
JfoJWampi fjiampt faZ1
Name of Carrier
Date Shipped
poundC) ~j ltypound
Airbill Number
copy Sample Description
Surface Water
V firoiinH Water
Leachate
copy SAMPLE C( DNCENTRATION copy Ship To Of bull tlt (Cl leckOne) bullgtbull V C( ty finlt- ty
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Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office IO I- bullbullbullbull c bullbull Agtxlaquoina Vnyimu22313 703 S57 2490 bullIV1 gt7 2490 Sample Number i ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
(laquoraquo Mr Dfisignate helow QC
T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Attn
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0 ANALYSIS LAB
Perrj by
DarfiRfirH- ~~
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
X^ ixxdi= Alexandra VA 22313 703 557 2490 -FTS 5572490 IMA 8870 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION reg Case Number
(Check One) Sample Site NameCode Low ConctJiiUdlion
0 SAMPLE MATRIX (Check One)
J Water
(jj) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
(Phone) - - Dfltfi Shipper Sampling Date
Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
Task 3 Ammonia
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MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
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Sample Condition On Receipt
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INORGANICS TRAFnC REPORT ltT) Case Number gt
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Sample Description copy (Check One) bdquo Surface Water
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(specify) MATCHES ORGANIC SAMPLE NOshy
0 SAMPLE CONCENTRATION (Check One)
Low Conctjnlidliun
0 SAMPLE MATRIX (Check One)
mdash Water
(T) Shipping Information Name Of Carrier
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Datp SViipppfi
Airhill Niimher
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_raquopound Task 1 amp 2 Task 3 Ammonia
Sulhde Cyanide
TOC J_- _ FluondeamppH
LAB FILE COPY
(4) Ship To ^ bdquo 4
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Transfer Ship To
0 ANALYSIS LAB
PPI-H -vy r
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
M90-FTS 55
IMA 8872 bulllaquo PRO^
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Sample Site NameCode
(ji) Sampling Office
Sampling Personnel
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Sample Description copy (Check One) Surface Water
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MATCHES ORGANIC SAMPLE NOmdashimdash mdashgtshy
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Name Of Carrier
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Airbil Nimher lt bdquo
(a) Mark Volume Level On Sample Bottle Check Analysis required
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Sulfide Cyanide
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Transfer Ship To
(5) ANALYSIS LAB
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
)7-2490-FTS 5572490
IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
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Transfer Ship To
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
AJexandnc IMA 8874 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION (T) Case Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
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(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
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Transfer Ship To
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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(e) Shipping Information Name Of Carrier
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Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
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LAB FILE COPY
Sample Number
IMA 8876
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0 ANALYSIS LAB
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DateRfirH
Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO Bo
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Sample Site NameCode
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(a) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammnnifl
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Oifice Sample Number
A 1266 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office _Z Sampling Personnel
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(Begin) (End)
0 Shipping Information
1 K i t bull (t
Name of Carrier
Date Shipped
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Airbill Number
(|) Sample Description
Surface Water
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T earhate
copy SAMPLE C( DNCENTRATION 0 Ship To (Cl ieck One)
LowC Concentration Mediu im Concentration
Attn ^gt t r v l xy (f) SAMPLEM ATRIX
(Check Craquone) v Transfer
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(D For each sample collected sp ecify number (n) AnalysisLab i of containers used and markvolume level FWd Ky ^njc^KcL on each bottle DateRecd- ^^^-^J
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Water -(Extractable)
Water (VOA) shy
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
(jo) Special Handling Instructions (e g safety precautions hazardous nature)
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i BB US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^ bullbullbullbullbullptrade
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T ah Name f QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No bull_ V Designate below OC analysis selected Low Concentration
I ah Sample ID No (If Applicable) Medium Concentration
QT Report No Dunlicate SAMPLE MATRIX (Check One)
Matrix Spike Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
1 f
ExtractionPreparation T j l
(Dioxins)
Preparation(VOA) j
f
f sOti i
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
LowC loncentration Sample Site NameCode Mediu im Concentratic gt SEP 27 1982
Attn K bull - copy SAMPLEM ATRIX
(Check One) Transfer
^L Water SoiVS sdiment ShipTo $J(0
copy Regional Office 4- copy For each sample collected sp ecify number copy Analysis Lab j Sainpling Personnel of containers used and mark volume level Rlaquonrl Hy^T) l^^S^lu
on each bottle Date R^rl-^-jfD^^ L bull ^ ( Sample Condition
(Name) Approximate On Receipt (eg broken no 1 Number of
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(Phone) Water j 1 bull Sampling Date (Extractable) gt bull Water
J (Begin) (End) (VOA) v
Shipping Iniormation SoiV Sediment
Water bull bull r t shy (ExtVOA)
Name of Carrier Other
Date Shipped
h
Airbill Number
reg Sample Description copy Sample Location
Surface Water Mixed Media
firmrnri Water Sohds
Leachate Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
1
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office PC rxvcHht Vxin-n t V i ru in i Z3 i i 703 ^77490-ITo SIv90 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
i bullbull
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
Casft No Dp-RirjnatA helow QC analysis performed Low Concentration
Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
f
ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
S f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
-7 J i bull bull (Name)
(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
Tc i bull i v i Name of Carrier
Date Shipped
t 4 i
Airbill Number
Sample Description
Surf are Water
y Ground Water
Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
(Check One) Transfer
lt Water Cl_- Tgt ^)gt O jf
SoilSi sdiment Ship To Jgt7 nf )f
copy For each sample collected sp ecify number (n) Analysis Lab of containers used and markvolume level RlaquooH hy ^JVj (^5Scdj
on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
| gt i t
Name of Carrier
Date Shipped
--
Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
copy SAMPLE CC gtNCENTRATION 0 Ship To (Cl ieck One)
y LowC loncentration Mediu im Concentration SEP 27 1981
0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
SoilSlt adiment
0 For each sample collected sp ecify number AnalysisLab of containers used and mark volume level on each bottle Date Rflcd- lt poundyenpound
Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull y Ai gt ci V r IK H ij K7 Xvjl l - i l V b)7 2490 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HAQA Nrt ppHsignatfi below QC
T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
tt7 $~poundgt6amp (Phone)
(Begin) (End)
0 Shipping Information
Name of Carrier
asf-z Date Shipped
Airbill Number
reg Sample Description
Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
CvJi^shy
(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
r^sgt TSIn noltignfli-ft below QC
I ah Sample in NOanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
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Airbill Number
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0 SAMPLE CC 3NCENTRATION (Cl ieck One)
LowC Concentration Mediu m Concentration
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Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
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Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
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Sampling Date
(Begin) (End)
copy Shipping Information
JfoJWampi fjiampt faZ1
Name of Carrier
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poundC) ~j ltypound
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V firoiinH Water
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
Other (specify)
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T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
(laquoraquo Mr Dfisignate helow QC
T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
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Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
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Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Attn
Transfer Ship To
0 ANALYSIS LAB
Perrj by
DarfiRfirH- ~~
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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(Check One) Sample Site NameCode Low ConctJiiUdlion
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Sampling Personnel Name Of Carrier
(Name)
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Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
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Sulfide __^_ Solids Cyanide Oth sr TOf1
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MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
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Rerrt hy ^
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Sample Condition On Receipt
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0 SAMPLE CONCENTRATION (Check One)
Low Conctjnlidliun
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(T) Shipping Information Name Of Carrier
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M90-FTS 55
IMA 8872 bulllaquo PRO^
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Sampling Personnel
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Sample Description copy (Check One) Surface Water
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MATCHES ORGANIC SAMPLE NOmdashimdash mdashgtshy
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(J) Shipping Information
Name Of Carrier
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(4) Ship To
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Transfer Ship To
(5) ANALYSIS LAB
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
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Water
0 Shipping Information
Name Of Carrier - - tx
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Airhill Niimhfir bdquo
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LAB FILE COPY
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Transfer Ship To
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
AJexandnc IMA 8874 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION (T) Case Number
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Sampling Personnel Name Of Carrier
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
(5) Sampling Office
Sampling Personnel
(NflTTiegt)
(Phone) Sampling Date
(Begin) (End)
Sample Description copy (Check One) Si irface Wat^r
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Low Concentration
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Water
(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
Sulfide Cyanide
TOC _-_ Fluoride amp pH
LAB FILE COPY
0 Ship To
Attn
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0 ANALYSIS LAB if
Ro^hy H
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Sample Condition On Receipt
(eg broken leakage chain of custody etc ) I
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
SB- ^ INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Sampling Personnel
(Namfil
(Phone) Sampling Date
(Beoin) (End)
copy Sample Description (Check One)
Surf tiro WatPT f-JronnH W^t^r
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MATCHES ORGANIC SAMPLE NO
0 SAMPLE CONCENTRATION (Check One)
Low CuiiceiilidLiuii
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Water
(e) Shipping Information Name Of Carrier
Datlt=gt Shipped
Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
Sulfade Cyanide
fnr FlnnnHoamppH
LAB FILE COPY
Sample Number
IMA 8876
() Ship To
Attn
Transfer Ship To
0 ANALYSIS LAB
Rlaquov1hy bull mdash f 1 ^ i
DateRfirH
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
- -
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO Bo
IA 8877 INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
(2) SAMPLE CONCENTRATION (Check One)
Low ConceuUdhun
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Water
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Sampling Personnel
(e) Shipping Information
Name Of Carrier
(NaiTIA)
(Phone) Sampling Date
(Beam) (End)
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Airhill Number-
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(specify) MATCHES ORGANICSAMPTF NO _ mdash
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Task 1 amp 2 Task 3 Ammnnifl
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
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ExtractionPreparation(Acid)
ExtractionPreparationf(Pesticides)
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ExtractionPreparation T j l
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Preparation(VOA) j
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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Designate below QC analysis performed
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Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Lab Sraquonpllaquo TD Noanalysis selected
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QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
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Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
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(D SAMPLE CONCENTRATION Ship To (Check One)
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Attn SAMPLE MATRIX
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Water (VOA)
SoilSediment
Water (ExtVOA)
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Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
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Case No
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Designate below OC analysis selected
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Low Concentration Medium Concentration
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Matrix Spike Water laquoN Oi2
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
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Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Matrix Spike Water
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SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
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Matrix Spike QV ft n (Check One)
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Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
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Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
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Mixed Media
Solid
Other (specify)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
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Leachate
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SAMPLE MATRIX (Check One)
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For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
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Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
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Water (ExtVOA)
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Mixed Media
Solids
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Ship To If ft f
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Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Designate below QC analysis performed
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Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
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Sample Site NameCode
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Sampling Date
(Begin) (End)
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(3) SAMPLE MATRIX (Check One)
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Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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Sample Site NameCode
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copy Shipping Information
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Water (Extractable) a I11
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Mixed Media
Solids
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Sampling Personnel
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Surface Water r Ground Water
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Name Of Carrier
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LAB FILE COPY
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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Task 1 amp 2 Task 3 Ammonia
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Sample Number
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier
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Airbill MiimhfiTshy
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Sample Condition On Receipt
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LAB FILE COPY
(4) Ship To - 1 A
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(9) ANALYSIS LAB
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
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Low CunceutidLiou
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Water SoilSedirnpnt
(e) Shipping Information
Name Of Carrier s
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Airhill Niimhfir
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Sulfide Cyanide
TOC Fl^^nHo laquor pH
LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Low Concentration
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Water
(e) Shipping Information
Name Of Carrier f t flt f raquo - f
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Airbil l NiimhRr
(a) Mark Volume Level On Sample Bottle Check Analysis required
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LAB FILE COPY
0 Ship To
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R0H hy f
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Sample Condition On Receipt
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v
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
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(Begin) (End) J shy
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(5) SAMPLE MATRIX (Check One)
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LAB FILE COPY
(5) Ship To v^1 A
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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Sampling Personnel Name Of Carrier it
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Burfarp Water Check Analysis required laquo GifounH Wfltpr - lt - Cs_i_ Task 1 amp 2
Tflsk 3 Ammonia Sulfide Solids
OtW Cyanide
TOC (specify) L - Fluoride amp pH
MATCHES ORGANIC SAMPLE NO
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number gt T+bull Ai-ri-bjVirqinj22313- 703557-2490-FTS557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
LabName__L QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No
Lab Sample ID No
Designate below QC analysis performed
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate ^ SAMPLE MATRIX
Matrix Spike - t
Water
f (Check One)
SoilSediment
Analyst Signature Detail Below Pertinent Information andor Description DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
a A 1267 ORGANICS TRAFFIC REPORT copy Case Number copy SAMPLE CC DNCENTRATIC )N 0 Ship To V ^
(Cl ieck One) -
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
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QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
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Surf ace Water
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Mixed Media
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(10) Special Handling Instructions (eg safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
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Designate below OC analysis selected
(Tf Applicable)
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Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
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Low Concentration Medium Concentration
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Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
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Matrix Spike QV ft n (Check One)
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Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
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Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
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ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
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Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
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Matrix Spike Water
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Lab Sample ID Nltraquo
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Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Water (VGA)
SoilSediment
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Name of Carrier Other
-t-f-Date Shipped
Airbill Number
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Surf ace Water Mixed Media
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Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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Water (VOA) 2 ^lt
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Solids
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
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Name of Carrier
Date Shipped
Airbill Number
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Surf ace Water
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Leachate
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Low Concentration Medium Concentration SEP 2 7 1982
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Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
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Case No
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Designate below OC analysis selected
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Low Concentration Medium Concentration
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SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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Matrix Spike MQV ) laquo (Check One)
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Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
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Sampling Date
(Begin) (End)
(T) Shipping Information
Tc i bull i v i Name of Carrier
Date Shipped
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Airbill Number
Sample Description
Surf are Water
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Leachate
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LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
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Water (VOA)
SoilSediment
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Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
| gt i t
Name of Carrier
Date Shipped
--
Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
copy SAMPLE CC gtNCENTRATION 0 Ship To (Cl ieck One)
y LowC loncentration Mediu im Concentration SEP 27 1981
0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
SoilSlt adiment
0 For each sample collected sp ecify number AnalysisLab of containers used and mark volume level on each bottle Date Rflcd- lt poundyenpound
Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HAQA Nrt ppHsignatfi below QC
T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
tt7 $~poundgt6amp (Phone)
(Begin) (End)
0 Shipping Information
Name of Carrier
asf-z Date Shipped
Airbill Number
reg Sample Description
Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
CvJi^shy
(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullbullbull US ENVIRONMENTAL PROTECTION AGENCY HWISomf BtlaquolH PO Box 8 1 8 Alexandria Virginia 223 13-703 557-2490 FTS 557-2490 mmn ~
iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
r^sgt TSIn noltignfli-ft below QC
I ah Sample in NOanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
bull7 o gt z Date Snipped
Airbill Number
0 Sample Description
Surface Water bull Ground Water
Learhate
0 SAMPLE CC 3NCENTRATION (Cl ieck One)
LowC Concentration Mediu m Concentration
0 SAMPLE MATRIX (Check Otae) t
bull Water SouS adiment
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0 For each sample collected sp ecify number (TT) Analynifi LiAb i of containers used and mark volume level pLrl hyy^7-^ltSr flL on each bottle Date R H- 9 -f^^
Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
ltc M SVC lt r J
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No - ~- Designate below OC analysis selected Low Concentration
T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
~~| T Ah NATTIlaquo QC REQUIREMENTS SAMPLE CONCENTRATION
(Check One) HARA Nn Designate below QC
analysis performed Low Concentration Lab Sample ID No (Tf Applicable) Medium Concentration
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
jMf^yampH(Phone)
Sampling Date
(Begin) (End)
copy Shipping Information
JfoJWampi fjiampt faZ1
Name of Carrier
Date Shipped
poundC) ~j ltypound
Airbill Number
copy Sample Description
Surface Water
V firoiinH Water
Leachate
copy SAMPLE C( DNCENTRATION copy Ship To Of bull tlt (Cl leckOne) bullgtbull V C( ty finlt- ty
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copy For each sample collected sp ecify number (n) AnalysisLab bullbull of containers used and mark volume level on each bottle Date RACU- 7^5SJ
ij|fimT3ft ^^oncntioii on Receipt (eg broken ac Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office IO I- bullbullbullbull c bullbull Agtxlaquoina Vnyimu22313 703 S57 2490 bullIV1 gt7 2490 Sample Number i ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
(laquoraquo Mr Dfisignate helow QC
T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
y Water
(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Attn
Transfer Ship To
0 ANALYSIS LAB
Perrj by
DarfiRfirH- ~~
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
V
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
X^ ixxdi= Alexandra VA 22313 703 557 2490 -FTS 5572490 IMA 8870 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION reg Case Number
(Check One) Sample Site NameCode Low ConctJiiUdlion
0 SAMPLE MATRIX (Check One)
J Water
(jj) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
(Phone) - - Dfltfi Shipper Sampling Date
Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
Task 3 Ammonia
Sulfide __^_ Solids Cyanide Oth sr TOf1
(specify) ^_ Fluoride amp pH
MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
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0 ANALYSIS LAB
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Sample Condition On Receipt
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Sample Site NameCode
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(Phone) Sampling Date
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____ Solids nth^r
(specify) MATCHES ORGANIC SAMPLE NOshy
0 SAMPLE CONCENTRATION (Check One)
Low Conctjnlidliun
0 SAMPLE MATRIX (Check One)
mdash Water
(T) Shipping Information Name Of Carrier
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Datp SViipppfi
Airhill Niimher
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_raquopound Task 1 amp 2 Task 3 Ammonia
Sulhde Cyanide
TOC J_- _ FluondeamppH
LAB FILE COPY
(4) Ship To ^ bdquo 4
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Transfer Ship To
0 ANALYSIS LAB
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Sample Condition On Receipt
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M90-FTS 55
IMA 8872 bulllaquo PRO^
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Sample Site NameCode
(ji) Sampling Office
Sampling Personnel
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Sample Description copy (Check One) Surface Water
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MATCHES ORGANIC SAMPLE NOmdashimdash mdashgtshy
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Water
(J) Shipping Information
Name Of Carrier
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Airbil Nimher lt bdquo
(a) Mark Volume Level On Sample Bottle Check Analysis required
_L Task 1 amp 2 - Task 3 Ammonia
Sulfide Cyanide
TOC FlnnrHeamppH
LAB FJLE COPY
(4) Ship To
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Attn
Transfer Ship To
(5) ANALYSIS LAB
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DateRfir-rf ^
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
)7-2490-FTS 5572490
IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
Sample Site NameCode
(cpound) Samplina Office
Sampling Personnel
(Name-)
(Phone) Sampling Date
(Beam) (End) r
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Sample Description copy (Check One) bdquo Surface Water
(Ground Wfltor
__ Solids nthpr
(specify) MATCHES ORGANIC SAMPLE NO
0 SAMPLE CONCENTRATION (Check One)
Low CoiicenlidLion
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier - - tx
Datp Shipper)
Airhill Niimhfir bdquo
(J) Mark Volume Level On Sample Bottle Check Analysis required
_ Task 1 amp 2 Task 3 Ammonia
Sulfide Cyanide
TOC T - - Fluoride amp pH
LAB FILE COPY
0 Ship To ft
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Transfer Ship To
0 ANALYSIS LAB
PPCT) by -
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Sample Condition On Receipt
(eg broken leakage chain of custody etc )
J -1
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
AJexandnc IMA 8874 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION (T) Case Number
(Check One) Sample Site NameCode Luw Cuiiceiilidliua
0 SAMPLE MATRIX (Check One)
Water
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Sampling Personnel Name Of Carrier
A i (Name) J
(Phone) f DstB RmppeH t
Sampling Date Airhll Niimhpsr
(Beam) (End)
Sample Description (a) Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required GSronnd Water
Ta=lr 1 K
Taslf S Ammonia
Sulfide Solids Cyanide OtVmr
TOC (specify) f ^ - - Fluoride amp pH MATCHES ORGANIC SAMPI K MO 1
LAB FILE COPY
Ship To i
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
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Low Concentration
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Water
(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
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TOC _-_ Fluoride amp pH
LAB FILE COPY
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0 ANALYSIS LAB if
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
SB- ^ INORGANICS TRAFFIC REPORT (T) Case Number
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(e) Shipping Information Name Of Carrier
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Airhill Niimhfir-
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Sample Number
IMA 8876
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO Bo
IA 8877 INORGANICS TRAFFIC REPORT reg Case Number
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_____ Solids Oth mshy
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
rub^vcU Alexandria VA22313 703 557-2490-FTS 5572490 IMA SSTS PRddeg INORGANICS TRAFHC REPORT
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0 SAMPLE MATRIX (Check One)
Water _ SoilSedimpnt
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Sampling Personnel Name Of Carrier
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Airbill MiimhfiTshy
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Sample Description (J) Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required fiTrgtunH Watdegr
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
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(5) SAMPLE MATRIX (Check One)
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Name Of Carrier
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LAB FILE COPY
(5) Ship To v^1 A
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Attn
Transfer Ship To
() ANALYSIS LAB
TD u raquo A r lt pprrl hy
DateRttrH
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
SSJ IA 8883 INORGANICS TRAFnC REPORT 0 SAMPLE CONCENTRATION (T) Case Number _ bdquo 0 Ship To shy
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Tflsk 3 Ammonia Sulfide Solids
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TOC (specify) L - Fluoride amp pH
MATCHES ORGANIC SAMPLE NO
LAB FILE COPY
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T jh Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No shy Designate below CXI (Check One)
Lab Sraquonpllaquo TD Noanalysis selected
(Tf Applicable) Low Concentration Medium Concentration
QC Report No Di mlirate SAMPLE MATRIX
Matrix Spike Water
(Check One) _ HQV Ol W
Soil Sediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA) r
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation (Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Lab Name QH RFQI IIREMENTS SAMPLE CONCENTRATION (Check One)
Casft No Dp-RirjnatA helow QC analysis performed Low Concentration
Lab Sample ID Nn (Tf Applirahle) Medium Concentration
QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
r c v ils i) i Matrix Spike y (too
SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
f
ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
S f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
-7 J i bull bull (Name)
(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
Tc i bull i v i Name of Carrier
Date Shipped
t 4 i
Airbill Number
Sample Description
Surf are Water
y Ground Water
Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
(Check One) Transfer
lt Water Cl_- Tgt ^)gt O jf
SoilSi sdiment Ship To Jgt7 nf )f
copy For each sample collected sp ecify number (n) Analysis Lab of containers used and markvolume level RlaquooH hy ^JVj (^5Scdj
on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
iB^ffi US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^BpBlaquoraquoiippM
KiBJgll ORGANTCS LABORATORY CHRONICLE (EXTRACTIONS) ^jjjjjlj^
I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
| gt i t
Name of Carrier
Date Shipped
--
Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
copy SAMPLE CC gtNCENTRATION 0 Ship To (Cl ieck One)
y LowC loncentration Mediu im Concentration SEP 27 1981
0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
SoilSlt adiment
0 For each sample collected sp ecify number AnalysisLab of containers used and mark volume level on each bottle Date Rflcd- lt poundyenpound
Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull y Ai gt ci V r IK H ij K7 Xvjl l - i l V b)7 2490 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HAQA Nrt ppHsignatfi below QC
T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
bullV
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
tt7 $~poundgt6amp (Phone)
(Begin) (End)
0 Shipping Information
Name of Carrier
asf-z Date Shipped
Airbill Number
reg Sample Description
Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
CvJi^shy
(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullbullbull US ENVIRONMENTAL PROTECTION AGENCY HWISomf BtlaquolH PO Box 8 1 8 Alexandria Virginia 223 13-703 557-2490 FTS 557-2490 mmn ~
iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
r^sgt TSIn noltignfli-ft below QC
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
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(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
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Mixed Media
Solids
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Ship To If ft f
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T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Designate below QC analysis performed
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Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
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Sample Site NameCode
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For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
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Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Name Of Carrier s
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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QT Report Nr Hi mlir^t^ SAMPLE MATRIX ^p (Check One)
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SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
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(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
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amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
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Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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(Begin) (End)
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(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
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Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
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Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
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(Phone) Sampling Date y i i gt
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Water (VOA) _ j Soil Sediment
Water (ExtVOA)
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Mixed Media
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Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
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Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
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Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
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Low Concentration Medium Concentration
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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LowrC Concentration Mediu im Concentration
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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Water (Extractable) f
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SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
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) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
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Mixed Media
Solids
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(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
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Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Lab Sample ID Nltraquo
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(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Sample Site NameCode
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(Begin) (End)
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(3) SAMPLE MATRIX (Check One)
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For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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Mixed Media
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I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
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(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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Surface Water r Ground Water
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(specify) MATCHES ORGANir SAMPLF NO
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Low Cuuctmlidliuii
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Water
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Name Of Carrier
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(B) Mark Volume Level On Sample Bottle Check Analysis required
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LAB FILE COPY
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M90-FTS 55
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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OtW Cyanide
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MATCHES ORGANIC SAMPLE NO
LAB FILE COPY
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1268 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
copy Regional Office_ Sampling Personnel
(Name) bull -
(Phone)
Sampling Date
(Begin) (End)
(D Shipping Information
Name of Carrier
Date Shipped
Airbill Number
copy Sample Description
Surf ace Water
L Ground Water
Leachate
(D SAMPLE CONCENTRATION Ship To (Check One)
Low Concentration Medium Concentration SEP 2 7 1982
Attn SAMPLE MATRIX
(Check One)
Water SoilSediment
Transfer ShipTo
Por each sample collected specify number 0) Anal of containers used and mark volume level Recdby dL on each bottle Pate Recd
amide Condition on Receipt (eg broken mNumber of Approximate ice Chaunrf-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number bullbullbullOYX bull- A-vr v Wi i ru- i fOi 03 bv 4iO P fgt Jib 2490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
ThNwne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
I flh Sample TO No
Designate below OC analysis selected
(Tf Applicable)
(Check One)
Low Concentration Medium Concentration
Qlt~ Report No Duplicate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN Oi2
SoilSediment t [
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
S f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
i PO Box 818 AlexandriaVirginia 22313-703 557-2490 -FTS 557-2490
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
T ah Nilaquoe QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
r3laquo Nrraquo Designate helow OC
Lab Sample ID No analysis performed
(Tf Applicable) Low Concentration Medium Concentration
DT Praquoprraquorf Nn HT mlirflte SAMPLE MATRIX
Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
-7 J i bull bull (Name)
(Phone)
Sampling Date
(Begin) (End)
(T) Shipping Information
Tc i bull i v i Name of Carrier
Date Shipped
t 4 i
Airbill Number
Sample Description
Surf are Water
y Ground Water
Leachate
(D SAMPLE CC 3NCENTRATIC )N copy Ship To (Ci ieck One)
LowC loncentration __ Mediu m Concentratio m SEP 2 7 190
Attn ltbull v l copy SAMPLEM ATRIX
(Check One) Transfer
lt Water Cl_- Tgt ^)gt O jf
SoilSi sdiment Ship To Jgt7 nf )f
copy For each sample collected sp ecify number (n) Analysis Lab of containers used and markvolume level RlaquooH hy ^JVj (^5Scdj
on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
iB^ffi US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office ^BpBlaquoraquoiippM
KiBJgll ORGANTCS LABORATORY CHRONICLE (EXTRACTIONS) ^jjjjjlj^
I ah Name QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ah Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
| gt i t
Name of Carrier
Date Shipped
--
Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
copy SAMPLE CC gtNCENTRATION 0 Ship To (Cl ieck One)
y LowC loncentration Mediu im Concentration SEP 27 1981
0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
SoilSlt adiment
0 For each sample collected sp ecify number AnalysisLab of containers used and mark volume level on each bottle Date Rflcd- lt poundyenpound
Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull y Ai gt ci V r IK H ij K7 Xvjl l - i l V b)7 2490 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HAQA Nrt ppHsignatfi below QC
T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
bullV
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Leachate
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LowrC Concentration Mediu im Concentration
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(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
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SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
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(Ijlame)
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(Begin) (End)
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Sample Condittom on Receipt (eg broken nc Number of Approximate
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SoiVSediment
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Mixed Media
Solids
Other (specify)
Ship To If ft f
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Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
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Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
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Name of Carrier Other
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Surf ace Water Mixed Media
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(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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Water (VOA) 2 ^lt
SoilSediment
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Mixed Media
Solids
Other (specify)
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QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
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(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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Surface Water r Ground Water
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Low Cuuctmlidliuii
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Name Of Carrier
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Sample Condition On Receipt
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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Name Of Carrier
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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Task 1 amp 2 Task 3 Ammonia
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Sample Number
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Airbill MiimhfiTshy
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
reg Case Number Sample Site NameCode
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Water SoilSedirnpnt
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Name Of Carrier s
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Airhill Niimhfir
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i_ Task 1 amp 2 Tsslf 3 Ammonia
Sulfide Cyanide
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LAB FILE COPY
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) i
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ExtractionPreparation^
(Dioxins) i
Preparation(VGA) gt A
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
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r3laquo Nrraquo Designate helow OC
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(Tf Applicable) Low Concentration Medium Concentration
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Matrix Spike MQV ) laquo (Check One)
(9 Water SoilSediment
Draquolaquorrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
copy Regional Office- bull Sampling Personnel
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on each bottle Date Rlaquocri- 9 P3- f ^jarnpjp Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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T ah Sample ID No
Designate below OC analysis selected
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Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
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Matrix Spike QV ft n (Check One)
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Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
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(Phone) Sampling Date y i i gt
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Water (VOA) _ j Soil Sediment
Water (ExtVOA)
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Mixed Media
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Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
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SAMPLE MATRIX (Check One)
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For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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Airbill Number
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LowrC Concentration Mediu im Concentration
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullbullbull US ENVIRONMENTAL PROTECTION AGENCY HWISomf BtlaquolH PO Box 8 1 8 Alexandria Virginia 223 13-703 557-2490 FTS 557-2490 mmn ~
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
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(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
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Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
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0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
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(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
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Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
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(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
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__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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(Check One) HARA Nn Designate below QC
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
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Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Complete section below only if sample is used for duplicate or spike analyses
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Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1269 ORGANICS TRAFFIC REPORT (T) Case Number
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ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
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BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
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Sample Location
Mixed Media
Solids
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(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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Water (ExtVOA)
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(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
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Sample Site NameCode i
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Solids
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Ship To If ft f
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ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Airbill MiimhfiTshy
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
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Water SoilSedirnpnt
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Airhill Niimhfir
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ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
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Matrix Spike QV ft n (Check One)
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Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
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Sample Site NameCode
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SAMPLE CONCENTRATION S Ship To (Check One)
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For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
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Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
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(10) Special HandUng Instructions (eg safety precautions hazardous nature)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
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Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
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Mixed Media
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ExtractionPreparation (BaseNeutral)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Name of Carrier Other
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Surf ace Water Mixed Media
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(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Matrix Spike _ Water flOl
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
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(Tf Applicable) Low Concentration Medium Concentration
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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LAB FILE COPY
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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Low Concentration Medium Concentration
QC Rlaquoprgtrf No Dunlicate SAMPLE MATRIX
Matrix Spike Water
(Check One) UQMUN Oil
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation(BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides) gt
ExtractionPreparation(Dioxins)
Preparation(VGA)
-
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation(VGA) QC
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT Report No Hi ml irate SAMPLE MATRIX
Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
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Name of Carrier
Date Shipped
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Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
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0 SAMPLEM ATRIX (Check One) 4
Transfer gt Water
SoilSlt adiment
0 For each sample collected sp ecify number AnalysisLab of containers used and mark volume level on each bottle Date Rflcd- lt poundyenpound
Sample Condition on Receipt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable)
Water (VOA) _ j Soil Sediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solid
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office bull bull y Ai gt ci V r IK H ij K7 Xvjl l - i l V b)7 2490 Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HAQA Nrt ppHsignatfi below QC
T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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Sampling Personnel
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(Begin) (End)
0 Shipping Information
Name of Carrier
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Airbill Number
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Surf are Water
( Omiind Water
Leachate
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LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullbullbull US ENVIRONMENTAL PROTECTION AGENCY HWISomf BtlaquolH PO Box 8 1 8 Alexandria Virginia 223 13-703 557-2490 FTS 557-2490 mmn ~
iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
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(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
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Airbill Number
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Sample Condittom on Receipt (eg broken nc Number of Approximate
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Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Designate below QC analysis performed
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Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
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Sample Site NameCode
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Sampling Date
(Begin) (End)
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(3) SAMPLE MATRIX (Check One)
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Ship To irraquof jgtr~
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For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
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Name of Carrier Other
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Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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Water (Extractable) a I11
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Mixed Media
Solids
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Sampling Personnel
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Surface Water r Ground Water
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Name Of Carrier
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LAB FILE COPY
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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Low Concentration
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Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
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Sample Number
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier
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Airbill MiimhfiTshy
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Sample Condition On Receipt
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_ FtiirH^pH MATCHES ORGANIC S AMPT R NO _
LAB FILE COPY
(4) Ship To - 1 A
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Water SoilSedirnpnt
(e) Shipping Information
Name Of Carrier s
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Airhill Niimhfir
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Sulfide Cyanide
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LAB FILE COPY
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
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(Begin) (End) J shy
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LAB FILE COPY
(5) Ship To v^1 A
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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Sampling Personnel Name Of Carrier it
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Burfarp Water Check Analysis required laquo GifounH Wfltpr - lt - Cs_i_ Task 1 amp 2
Tflsk 3 Ammonia Sulfide Solids
OtW Cyanide
TOC (specify) L - Fluoride amp pH
MATCHES ORGANIC SAMPLE NO
LAB FILE COPY
US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box818 Alexandria Virginia 22313-703557-2490 FTS 557-2490
ORGAN1CS LABORATORY CHRONICLE (ANALYSIS)
T Ah Nam QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
faisraquo No n^Rignatp hfilow QC
Lab Sample ID Noanalysis performed
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Matrix Spike QV ft n (Check One)
t V if VA-
Wflter SoilSediment
Doerrinti on Aivaljrst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1270 ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode
0 Region Office- i Sampling Personnel
- - - A i (Name)
(Phone) Sampling Date y i i gt
(Begin) (End)
0 Shipping Information
| gt i t
Name of Carrier
Date Shipped
--
Airbill Number
0 Sample Description
Surface Water
Ground Water
Leachate
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
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Name of Carrier
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Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
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SAMPLE MATRIX (Check One)
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Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
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Designate below OC analysis selected
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Site NameCode
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Ground Water
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Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
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(10) Special HandUng Instructions (eg safety precautions hazardous nature)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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(If Applicable) Low Concentration Medium Concentration
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Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
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Matrix Spike Water
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
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Surf ace Water Mixed Media
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Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
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Water (Extractable) a I11
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Water (ExtVOA)
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Mixed Media
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T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
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T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
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Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
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Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
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Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Transfer Ship To
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Sample Condition On Receipt
(eg broken leakage chain of custody etc )
V
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
M90-FTS 55
IMA 8872 bulllaquo PRO^
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Name Of Carrier
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Airbil Nimher lt bdquo
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Sulfide Cyanide
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
)7-2490-FTS 5572490
IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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(5) Sampling Office
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(Phone) Sampling Date
(Begin) (End)
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Low Concentration
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(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
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0 ANALYSIS LAB if
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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Sample Number
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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(Check One) Sample Site NameCode Luw Cuiicenlidliou
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(e) Shipping Information
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Sample Site NameCode
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Sampling Personnel
(Nflmp)
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(Begin) (End)
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Water
(e) Shipping Information
Name Of Carrier f t flt f raquo - f
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
(j Satnplina Office
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(Name) -
(Phone) Sampling Date
(Begin) (End) J shy
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(5) SAMPLE MATRIX (Check One)
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() Shipping Information
Name Of Carrier
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D^tfi RViippesfi t
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LAB FILE COPY
(5) Ship To v^1 A
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TD u raquo A r lt pprrl hy
DateRttrH
Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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Sampling Personnel Name Of Carrier it
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MATCHES ORGANIC SAMPLE NO
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATtifi I ) QC REQUIREMENTS SAMPLE CONCENTRATION i (Check One)
Case No Designate below OC analysis selected Low Concentration
I^h Sample TO No (Tf Applicable) Medium Concentration
QC PfraquopoH- No D iplirate SAMPLE MATRIX (Check One)
Matrix Spike Water laquoN ^ Soil Sediment
Description TechniciaGCl Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation(Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation ft (Dioxins)
Preparation(VGA) lt i
- V
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
BSHB US ENVIRONMENTAL PROTECnON AGENCY HWISomi BrlB PO Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 PTS -557 2490 fHfH ~~JSi a ORGANICS LABORATORY CHRONICLE ( bull
T ah Nmlaquo QT REQUIREMENTS SAMPLE CONCENTRATION (Check One)
HAQA Nrt ppHsignatfi below QC
T ah Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No HT mlirota ^ SAMPLE MATRIX
Matrix Spike tty n (Check One)
9 Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
_bull Water SoiVSediment
Transfer Ship To
For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
T ab Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
OT Report No Duplicate SAMPLE MATRIX (Chec^eOlW
Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
(Check One) CflS^No
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Plaquotignfltfi hfilowQC analysis performed
(Tf Applirahle^ Low Concentration Medium Concentration
QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
- Sa^SiteNan-eCode
(s) RecriorM Offiw ^ff ^ bull^-s if
Sampling Personnel
tt7 $~poundgt6amp (Phone)
(Begin) (End)
0 Shipping Information
Name of Carrier
asf-z Date Shipped
Airbill Number
reg Sample Description
Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
CvJi^shy
(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullbullbull US ENVIRONMENTAL PROTECTION AGENCY HWISomf BtlaquolH PO Box 8 1 8 Alexandria Virginia 223 13-703 557-2490 FTS 557-2490 mmn ~
iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
r^sgt TSIn noltignfli-ft below QC
I ah Sample in NOanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
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Airbill Number
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0 SAMPLE CC 3NCENTRATION (Cl ieck One)
LowC Concentration Mediu m Concentration
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0 For each sample collected sp ecify number (TT) Analynifi LiAb i of containers used and mark volume level pLrl hyy^7-^ltSr flL on each bottle Date R H- 9 -f^^
Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Lab Sample ID Nltraquo
Designate below QC analysis performed
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Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
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Water (VGA)
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Name of Carrier Other
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Airbill Number
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Surf ace Water Mixed Media
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Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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Mixed Media
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Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Low Concentration
0 SAMPLE MATRIX (Check One)
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(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
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Task 1 amp 2 Task 3 Ammonia
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Sampling Personnel Name Of Carrier
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1271 ORGANICS TRAFFIC REPORT T) Case Number
Sample Site NameCode
0 Regional Office Z Sampling Personnel
(Phone)
Sampling Date hfiA
(T) Shipping Information
Name of Carrier
Date Snipped
Airbill Number
(s) Sample Description
Surface Water
Ground Water
Leachate
SAMPLE CONCENTRATION S Ship To (Check One)
f Low Concentration Medium Concentration
SAMPLE MATRIX (Check One)
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For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
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Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
Other
Sample Location
Mixed Media
Solids
Other (specify)
(10) Special HandUng Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number PO Box 818 dew maiia Virginia 22313 703 557490 laquoFiT b 72490
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hName QC REQUIREMENTS SAMPLE CONCENTRATION
Case No
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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Water (ExtVOA)
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(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
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Sample Site NameCode i
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Solids
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Ship To If ft f
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ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Airbill MiimhfiTshy
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
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Water SoilSedirnpnt
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Airhill Niimhfir
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For each sample collected specify number Icopy Analysis Lab of containers used and mark volume level Recd hy-f H O on each bottle
Sample Condition Number of Approximate on Receipt (eg broken nt
Total Volume ice Chain-of-Custody etc) Containers Water (Extractable)
Water (VGA)
SoiVSediment
Water (ExtVOA)
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Sample Location
Mixed Media
Solids
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(10) Special HandUng Instructions (eg safety precautions hazardous nature)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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LowrC Concentration Mediu im Concentration
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Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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SoilSediment
Water (ExtVOA)
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Mixed Media
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(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
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Iflb Sample ID No
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ExtractionPreparation (BaseNeutral)
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Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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Water (Extractable) a I11
Water (VOA) 2 ^lt
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QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
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(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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Sampling Personnel
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(Beam) (End)
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Name Of Carrier
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LAB FILE COPY
(4) Ship To
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M90-FTS 55
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
)7-2490-FTS 5572490
IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
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Water
0 Shipping Information
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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(Phone) Sampling Date
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Low Concentration
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(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
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Matrix Spike Water SoilSediment f
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides)
ExtractionPreparation (Dioxins) bull ) 4gt
Preparation (VGA) ji
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
fSBffii US ENVIRONMENTAL PROTECTION AGENCY HWISomi BKlia PO Box 818 Alexandra Virginia 223 13-703 557-2490 -FTS 557-2490
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QT RlaquopoH- TMo Hi mlirata SAMPLE MATRIX titty g j^CheckOne)
Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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Sampling Personnel
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Mixed Media
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(If Applicable) Low Concentration Medium Concentration
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Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
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Iflb Sample ID No
Designate below OC analysis selected
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Matrix Spike Water
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Name of Carrier Other
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Surf ace Water Mixed Media
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(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
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T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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(Check One) Sample Site NameCode Low ConctJiiUdlion
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Sampling Personnel Name Of Carrier
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Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
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MATCHES ORGANIC SAMPLE NO -t-ii
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0 SAMPLE CONCENTRATION (Check One)
Low Conctjnlidliun
0 SAMPLE MATRIX (Check One)
mdash Water
(T) Shipping Information Name Of Carrier
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Airhill Niimher
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_raquopound Task 1 amp 2 Task 3 Ammonia
Sulhde Cyanide
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iSJggJI ORGAN1CS LABORATORY CHRONICLE C^ZZr ^H| T h Nlaquomlaquo OH RFQT ITREMENTS SAMPLE CONCENTRATION
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC(Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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SoilSediment
Water (ExtVOA)
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Mixed Media
Solids
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Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
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Sample Site NameCode i
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Sample Condittom on Receipt (eg broken nc Number of Approximate
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Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
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0 Sample Location
Mixed Media
Solids
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Ship To If ft f
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(To) Special Handling Instructions (e g safety precautions hazardous nature)
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
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Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
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Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Sample Site NameCode
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Sampling Date
(Begin) (End)
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For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
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SoilSediment
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Name of Carrier Other
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Airbill Number
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Surf ace Water Mixed Media
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Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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T ah Sample ID No (If Applicable^ Medium Concentration
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Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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Sample Site NameCode
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JfoJWampi fjiampt faZ1
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
Other (specify)
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Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
(laquoraquo Mr Dfisignate helow QC
T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
i
i k
Attn
Transfer Ship To
0 ANALYSIS LAB
Perrj by
DarfiRfirH- ~~
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
V
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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(Check One) Sample Site NameCode Low ConctJiiUdlion
0 SAMPLE MATRIX (Check One)
J Water
(jj) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
(Phone) - - Dfltfi Shipper Sampling Date
Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
Task 3 Ammonia
Sulfide __^_ Solids Cyanide Oth sr TOf1
(specify) ^_ Fluoride amp pH
MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
0 Ship To - gt
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Attn
Transfer Ship To
0 ANALYSIS LAB
Rerrt hy ^
DatfiRprH- ^
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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Sample Site NameCode
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Sampling Personnel
(Name)
(Phone) Sampling Date
(Beam) _ - (End)
Sample Description copy (Check One) bdquo Surface Water
_fc^mdash Ground Water
____ Solids nth^r
(specify) MATCHES ORGANIC SAMPLE NOshy
0 SAMPLE CONCENTRATION (Check One)
Low Conctjnlidliun
0 SAMPLE MATRIX (Check One)
mdash Water
(T) Shipping Information Name Of Carrier
- raquo
Datp SViipppfi
Airhill Niimher
0 Mark Volume Level On Sample Bottle Check Analysis required
_raquopound Task 1 amp 2 Task 3 Ammonia
Sulhde Cyanide
TOC J_- _ FluondeamppH
LAB FILE COPY
(4) Ship To ^ bdquo 4
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Transfer Ship To
0 ANALYSIS LAB
PPI-H -vy r
natBRlaquofH- y
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
M90-FTS 55
IMA 8872 bulllaquo PRO^
bullV INORGANICS TRAFFIC REPORT reg Case Number-
Sample Site NameCode
(ji) Sampling Office
Sampling Personnel
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(Phone)
Sampling Date
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Sample Description copy (Check One) Surface Water
f mdash Ground Water
Solids Other
(specify)
MATCHES ORGANIC SAMPLE NOmdashimdash mdashgtshy
SAMPLE CONCENTRATION (Check One) mdash Low Concentration
0 SAMPLE MATRIX (Check One)
Water
(J) Shipping Information
Name Of Carrier
- fiflt^ Shipped
Airbil Nimher lt bdquo
(a) Mark Volume Level On Sample Bottle Check Analysis required
_L Task 1 amp 2 - Task 3 Ammonia
Sulfide Cyanide
TOC FlnnrHeamppH
LAB FJLE COPY
(4) Ship To
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Transfer Ship To
(5) ANALYSIS LAB
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DateRfir-rf ^
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
)7-2490-FTS 5572490
IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
Sample Site NameCode
(cpound) Samplina Office
Sampling Personnel
(Name-)
(Phone) Sampling Date
(Beam) (End) r
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Sample Description copy (Check One) bdquo Surface Water
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(specify) MATCHES ORGANIC SAMPLE NO
0 SAMPLE CONCENTRATION (Check One)
Low CoiicenlidLion
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Water
0 Shipping Information
Name Of Carrier - - tx
Datp Shipper)
Airhill Niimhfir bdquo
(J) Mark Volume Level On Sample Bottle Check Analysis required
_ Task 1 amp 2 Task 3 Ammonia
Sulfide Cyanide
TOC T - - Fluoride amp pH
LAB FILE COPY
0 Ship To ft
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Transfer Ship To
0 ANALYSIS LAB
PPCT) by -
DatfiRfirH l
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
J -1
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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(Check One) Sample Site NameCode Luw Cuiiceiilidliua
0 SAMPLE MATRIX (Check One)
Water
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Sampling Personnel Name Of Carrier
A i (Name) J
(Phone) f DstB RmppeH t
Sampling Date Airhll Niimhpsr
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Sample Description (a) Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required GSronnd Water
Ta=lr 1 K
Taslf S Ammonia
Sulfide Solids Cyanide OtVmr
TOC (specify) f ^ - - Fluoride amp pH MATCHES ORGANIC SAMPI K MO 1
LAB FILE COPY
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
(5) Sampling Office
Sampling Personnel
(NflTTiegt)
(Phone) Sampling Date
(Begin) (End)
Sample Description copy (Check One) Si irface Wat^r
Ground Wfltor
Solids Othpr
(specify) MATCHES ORGANIC S AMPT K NO
0 SAMPLE CONCENTRATION (Check One)
Low Concentration
0 SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
Sulfide Cyanide
TOC _-_ Fluoride amp pH
LAB FILE COPY
0 Ship To
Attn
Transfer Ship To
0 ANALYSIS LAB if
Ro^hy H
natfiRfir-H 2
Sample Condition On Receipt
(eg broken leakage chain of custody etc ) I
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
SB- ^ INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Sampling Personnel
(Namfil
(Phone) Sampling Date
(Beoin) (End)
copy Sample Description (Check One)
Surf tiro WatPT f-JronnH W^t^r
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MATCHES ORGANIC SAMPLE NO
0 SAMPLE CONCENTRATION (Check One)
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0 SAMPLE MATRIX (Check One)
Water
(e) Shipping Information Name Of Carrier
Datlt=gt Shipped
Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
Sulfade Cyanide
fnr FlnnnHoamppH
LAB FILE COPY
Sample Number
IMA 8876
() Ship To
Attn
Transfer Ship To
0 ANALYSIS LAB
Rlaquov1hy bull mdash f 1 ^ i
DateRfirH
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
- -
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO Bo
IA 8877 INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
(2) SAMPLE CONCENTRATION (Check One)
Low ConceuUdhun
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Water
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Sampling Personnel
(e) Shipping Information
Name Of Carrier
(NaiTIA)
(Phone) Sampling Date
(Beam) (End)
Date Shipped
Airhill Number-
copy Sample Description (Check One)
- SurfsrB Water Glround Writer
_____ Solids Oth mshy
(specify) MATCHES ORGANICSAMPTF NO _ mdash
(a) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammnnifl
Sulfide Cyanide
Tor1
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LAB FILE COPY
(T) Ship To
Attn
Transfer Ship To
() ANALYSIS LAB
RwH Vy f i
DatfiRficHshy
^^^ f 1 ^ J ^AM
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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0 SAMPLE CONCENTRATION reg Case Number (Check One) Sample Site NameCode
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0 SAMPLE MATRIX (Check One)
Water _ SoilSedimpnt
(5) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
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Airbill MiimhfiTshy
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Sample Description (J) Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required fiTrgtunH Watdegr
Task 1 amp 2 Task 3 Ammnnia
Sulfide Solids Cyanide nthfir
TOG (specify) FliirHlaquo pH
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DateRfirH- ^ ^
Sample Condition On Receipt
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(Check One) Sample Site NameCode Luw Cuiicenlidliou
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(5) Sampling Office lt (e) Shipping Information
Sampling Personnel Name Of Carrier
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Task 1 amp 2 Tank 3 Ammonia
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_ FtiirH^pH MATCHES ORGANIC S AMPT R NO _
LAB FILE COPY
(4) Ship To - 1 A
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reg Case Number Sample Site NameCode
(jj) Sampling Office
Sampling Personnel
(Name) -
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(Beam) (End)
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_____ Solids OHi(=r
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SAMPLE CONCENTRATION (Check One)
Low CunceutidLiou
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Water SoilSedirnpnt
(e) Shipping Information
Name Of Carrier s
lt- i
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Airhill Niimhfir
(s) Mark Volume Level On Sample Bottle Check Analysis required
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Sulfide Cyanide
TOC Fl^^nHo laquor pH
LAB FILE COPY
(T) Ship To
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INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Sampling Personnel
(Nflmp)
(Phone) Sampling Date
(Begin) (End)
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M Surface Water _ (Ground Wfltpt
Solids Othmshy
(specify)
MATCHES ORGANIC SAMPLE NO
SAMPLE CONCENTRATION (Check One)
Low Concentration
reg SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier f t flt f raquo - f
Dfltp Shipped
Airbil l NiimhRr
(a) Mark Volume Level On Sample Bottle Check Analysis required
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LAB FILE COPY
0 Ship To
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R0H hy f
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
(j Satnplina Office
Sampling Personnel
(Name) -
(Phone) Sampling Date
(Begin) (End) J shy
Sample Description copy (Check One) Surface Water
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Solids Othpr
(specify) MATCHES ORGANIC S AMPI K NO
SAMPLE CONCENTRATION (Check One)
mdash Low Concentration
(5) SAMPLE MATRIX (Check One)
f Water
() Shipping Information
Name Of Carrier
_^
D^tfi RViippesfi t
Airhill Number
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Sulfide Cyanide
Tnr raquo__ FlnrHlaquo amp pH
LAB FILE COPY
(5) Ship To v^1 A
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Attn
Transfer Ship To
() ANALYSIS LAB
TD u raquo A r lt pprrl hy
DateRttrH
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
SSJ IA 8883 INORGANICS TRAFnC REPORT 0 SAMPLE CONCENTRATION (T) Case Number _ bdquo 0 Ship To shy
(Check One) Sample Site NameCode f mdash Low Concentration ^
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(5) Sampling Office 0 Shipping Information 0 ANALYSIS LAB
Sampling Personnel Name Of Carrier it
Ror-H Ky - -
(Nam)
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Sampling Date Airlr1 Niirphfir shy
(Beam) (End)
Sample Condition On Receipt Sample Description (^ Mark Volume Level copy (Check One) On Sample Bottle (eg broken leakage chain of custody etc )
Burfarp Water Check Analysis required laquo GifounH Wfltpr - lt - Cs_i_ Task 1 amp 2
Tflsk 3 Ammonia Sulfide Solids
OtW Cyanide
TOC (specify) L - Fluoride amp pH
MATCHES ORGANIC SAMPLE NO
LAB FILE COPY
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
A 1272 ORGAN1CS TRAFFIC REPORT 0 Case Number
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(Begin) (End)
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Airbill Number
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Surf are Water
( Omiind Water
Leachate
copy SAMPLE CC DNCENTRATION 0 Ship Toy Ir stf (gflpi C (Cl ieck One)
LowrC Concentration Mediu im Concentration
Q) SAMPLEM ATRIX (Check One)
Transfer ~ Water ampt 2s~ CJ SoiVS adiment Ship To v d
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(D For each sample collected sp ecify number copy AnfllyRJsLrab of containers used and mark volume level R^cd byM raquo 0 55 yn on each bottle nate RLpound5 SS- 1
Sftrnplfl Condition OXI Receipt (e ltj brokfln no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Water (Extractable) f
^ Water J F^raquoV (VGA)
SoilSediment
Water (ExtVOA)
Other
(D Sample Location
Mixed Media
Solids
Other (specify)
) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office lt gt xV A v gt r Yrlt nmj 7H3 5b7 2490 -HS raquo7149G Sample Number
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^hNATne QC REQUIREMENTS SAMPLE CONCENTRATION
Case No Designate below OC (Check One)
T jraquoh Sample ID Noanalysis selected
(If Applicable) Low Concentration Medium Concentration
QC Report No Duplicate SAMPLE MATRIX (Check OneL eamp)
Matrix Spike WN 01W Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
- J i f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
bullbullbull US ENVIRONMENTAL PROTECTION AGENCY HWISomf BtlaquolH PO Box 8 1 8 Alexandria Virginia 223 13-703 557-2490 FTS 557-2490 mmn ~
iBjjgsect ORGANICS LABORATORY CHRONICLE (j
T^h Name QH REQT IIREMENTS SAMPLE CONCENTRATION (Check One)
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(Tf Applicable) Low Concentration Medium Concentration
QC Report No T^1 mlirata - SAMPLE MATRIX fy y (Check One)
Matrix Spike Water ^ SoilSediment
D srrintion Anal^t Signature Detail Below Pertinent Information and or DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
ORGANICS TRAFFIC REPORT 0 Case Number
Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
(Ijlame)
(Phone) Sampling Date 7v 7^7 f^c^
(Begin) (End)
0 Shipping Information
fatffft pound5ltpj res Name of Camer
bull7 o gt z Date Snipped
Airbill Number
0 Sample Description
Surface Water bull Ground Water
Learhate
0 SAMPLE CC 3NCENTRATION (Cl ieck One)
LowC Concentration Mediu m Concentration
0 SAMPLE MATRIX (Check Otae) t
bull Water SouS adiment
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0 For each sample collected sp ecify number (TT) Analynifi LiAb i of containers used and mark volume level pLrl hyy^7-^ltSr flL on each bottle Date R H- 9 -f^^
Sample Condittom on Receipt (eg broken nc Number of Approximate
Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) o2 fraquol Water FP (VOA) 3
SoiVSediment
Water (ExtVOA)
Other
0 Sample Location
Mixed Media
Solids
Other (specify)
Ship To If ft f
XV tf^ 4 ]d| ^ ^ fe rn
Transfer
(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
y^ US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number A PO Box 818 AlexandriaVirginia22313-703557-249OFTS 557-2490 is
ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
rc^M^
Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
i gt I ltI -gt I
Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No - ~- Designate below OC analysis selected Low Concentration
T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
jMf^yampH(Phone)
Sampling Date
(Begin) (End)
copy Shipping Information
JfoJWampi fjiampt faZ1
Name of Carrier
Date Shipped
poundC) ~j ltypound
Airbill Number
copy Sample Description
Surface Water
V firoiinH Water
Leachate
copy SAMPLE C( DNCENTRATION copy Ship To Of bull tlt (Cl leckOne) bullgtbull V C( ty finlt- ty
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ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Pesticides
Dioxins
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Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) gt
ExtractionPreparation (Dioxins)
Preparation (VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation (BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
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Sample Site NameCode i
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
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Name of Carrier Other
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Airbill Number
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Surf ace Water Mixed Media
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(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Matrix Spike _ Water flOl
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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BaseNeutral
Acid
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC(Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office
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Sample Site NameCode i
0 Regional Office A^9 Sampling Personnel
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Water (Extractable) o2 fraquol Water FP (VOA) 3
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Mixed Media
Solids
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Ship To If ft f
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(To) Special Handling Instructions (e g safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number 1 u b v v - Abullraquo a iri Viiqinia gtpound-ni 703 557-M9j bullIIS 49J
ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
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Low Concentration Medium Concentration
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Matrix Spike Water
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Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
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Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
() Shipping Information
copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
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Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ah Sample ID No (If Applicable^ Medium Concentration
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Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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copy Sample Location
Mixed Media
Solids
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Name Of Carrier
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(B) Mark Volume Level On Sample Bottle Check Analysis required
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LAB FILE COPY
(4) Ship To
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T-ahNatne QC REQUIREMENTS SAMPLE CONCENTRATION
Craquolaquoe No
Iflb Sample ID No
Designate below OC analysis selected
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QC RlaquopJt No Duplicate SAMPLE MATRIX
Matrix Spike Water
(Check One)
wnM 01 W WW v SoilSediment JAgt i
n y^- Description Technician Signature Detail Below Pertinent Information andor
Date Time ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides) J
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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ORGANICS LABORATORY CHRONICLE (ANALYSIS)
ThNtrade QC REQUIREMENTS SAMPLE CONCENTRATION
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Lab Sample ID Nltraquo
Designate below QC analysis performed
(If Applicable)
(Check One)
Low Concentration Medium Concentration
QT Rlaquoprraquor+ No SAMPLE MATRIX
Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
(Phone)
Sampling Date
(Begin) (End)
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copy SAMPLE CONCENTRATION (Check One)
__ Low Concentration Medium Concentration
(3) SAMPLE MATRIX (Check One)
Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
le Condition On iteoapt (eg broken no Number of Approximateice Chain-of-Custody etc) Containers Total Volume
Sample Location
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T^hName QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
~~| T Ah NATTIlaquo QC REQUIREMENTS SAMPLE CONCENTRATION
(Check One) HARA Nn Designate below QC
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
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Sample Site NameCode
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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Iflb Sample ID No
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Matrix Spike Water
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ExtractionPreparation (Dioxins) bullill
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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Low Concentration Medium Concentration
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Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Sample Site NameCode
copy Regional Office Sampling Personnel
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Sampling Date
(Begin) (End)
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Water SoilSediment
Ship To irraquof jgtr~
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Transfer SEP 2 Ship To
For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
Water (Extractable)
Water (VGA)
SoilSediment
I jpoundffre Water (ExtVOA)
Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
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Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Matrix Spike Water SoilSediment
Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
jMf^yampH(Phone)
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(Begin) (End)
copy Shipping Information
JfoJWampi fjiampt faZ1
Name of Carrier
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office IO I- bullbullbullbull c bullbull Agtxlaquoina Vnyimu22313 703 S57 2490 bullIV1 gt7 2490 Sample Number i ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
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Sampling Personnel
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Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Attn
Transfer Ship To
0 ANALYSIS LAB
Perrj by
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
Task 3 Ammonia
Sulfide __^_ Solids Cyanide Oth sr TOf1
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MATCHES ORGANIC SAMPLE NO -t-ii
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Sample Condition On Receipt
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(specify) MATCHES ORGANIC SAMPLE NOshy
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Low Conctjnlidliun
0 SAMPLE MATRIX (Check One)
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(T) Shipping Information Name Of Carrier
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Datp SViipppfi
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0 Mark Volume Level On Sample Bottle Check Analysis required
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Sulhde Cyanide
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Sample Condition On Receipt
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Name Of Carrier
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(a) Mark Volume Level On Sample Bottle Check Analysis required
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Sulfide Cyanide
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LAB FJLE COPY
(4) Ship To
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(5) ANALYSIS LAB
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
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Airhill Niimhfir bdquo
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Site NameCode
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Sampling Personnel
(NflTTiegt)
(Phone) Sampling Date
(Begin) (End)
Sample Description copy (Check One) Si irface Wat^r
Ground Wfltor
Solids Othpr
(specify) MATCHES ORGANIC S AMPT K NO
0 SAMPLE CONCENTRATION (Check One)
Low Concentration
0 SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
Sulfide Cyanide
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LAB FILE COPY
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Sample Condition On Receipt
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0 SAMPLE MATRIX (Check One)
Water
(e) Shipping Information Name Of Carrier
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Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
Sulfade Cyanide
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LAB FILE COPY
Sample Number
IMA 8876
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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_____ Solids Oth mshy
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(a) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammnnifl
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Water _ SoilSedimpnt
(5) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
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Airbill MiimhfiTshy
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Sample Description (J) Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required fiTrgtunH Watdegr
Task 1 amp 2 Task 3 Ammnnia
Sulfide Solids Cyanide nthfir
TOG (specify) FliirHlaquo pH
MATPHRS ORGANIC SAMPIR MO --
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Sample Condition On Receipt
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Sulhde Solids Cyanide Other Tor (specify)
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LAB FILE COPY
(4) Ship To - 1 A
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Sample Site NameCode
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LAB FILE COPY
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Site NameCode
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(5) SAMPLE MATRIX (Check One)
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Name Of Carrier
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier it
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Matrix Spike Water SoilSediment
Draquolaquocrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC (VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI SoiTiple Management Office Sample Number
A 1274 ORGANICS TRAFFIC REPORT T) Case Number
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Sample Site NameCode
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(Begin) (End)
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(3) SAMPLE MATRIX (Check One)
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Ship To irraquof jgtr~
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For each sample collected specify number (n) Anal of containers used and mark volume level Recd by on each bottle
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Water (VGA)
SoilSediment
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Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
BfBBB US ENVIRONMENTAL PROTECTION AGENCY HWISomi Qfrly PO Box 818 Alexandria Virginia 223 13-703 557-2490 -FTS -557-2490 miimJSJBijgil ORGANICS LABORATORY CHRONICLE (j bull
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
ORGANICS TRAFFIC REPORT copy Case Number
Sample Site NameCode
() Regional QfPw^9 Sampling Personnel
jMf^yampH(Phone)
Sampling Date
(Begin) (End)
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JfoJWampi fjiampt faZ1
Name of Carrier
Date Shipped
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
Other (specify)
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QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
(laquoraquo Mr Dfisignate helow QC
T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
i
i k
Attn
Transfer Ship To
0 ANALYSIS LAB
Perrj by
DarfiRfirH- ~~
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
V
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
X^ ixxdi= Alexandra VA 22313 703 557 2490 -FTS 5572490 IMA 8870 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION reg Case Number
(Check One) Sample Site NameCode Low ConctJiiUdlion
0 SAMPLE MATRIX (Check One)
J Water
(jj) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
(Phone) - - Dfltfi Shipper Sampling Date
Airbill NiiTnh^ishy(Beoin) bdquo (End) k
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Task 3 Ammonia
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(specify) ^_ Fluoride amp pH
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Sulfide Cyanide
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
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TOC _-_ Fluoride amp pH
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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Airhill Niimhfir-
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Water (Extractable)
Water (VGA)
SoilSediment
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Name of Carrier Other
-t-f-Date Shipped
Airbill Number
copy Sample Description
Surf ace Water Mixed Media
^ Ground Water Solids
Leachate Other (specify)
(10) Special Handling Instructions (e g safety precautions hazardous nature)
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Sample Location
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T ah Sample ID No (If Applicable^ Medium Concentration
QT Report No Dnnlicate SAMPLE MATRIX (Check One)
Matrix Spike _ Water flOl
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
Preparation(VGA) i bull
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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Descrintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HW1 Sample Management Office
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Sample Site NameCode
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(Begin) (End)
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JfoJWampi fjiampt faZ1
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Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
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Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
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QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
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(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Transfer Ship To
0 ANALYSIS LAB
Perrj by
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Sample Condition On Receipt
(eg broken leakage chain of custody etc )
V
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier
(Name)
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Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
Task 3 Ammonia
Sulfide __^_ Solids Cyanide Oth sr TOf1
(specify) ^_ Fluoride amp pH
MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
0 Ship To - gt
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(Phone) Sampling Date
(Beam) _ - (End)
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(specify) MATCHES ORGANIC SAMPLE NOshy
0 SAMPLE CONCENTRATION (Check One)
Low Conctjnlidliun
0 SAMPLE MATRIX (Check One)
mdash Water
(T) Shipping Information Name Of Carrier
- raquo
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Airhill Niimher
0 Mark Volume Level On Sample Bottle Check Analysis required
_raquopound Task 1 amp 2 Task 3 Ammonia
Sulhde Cyanide
TOC J_- _ FluondeamppH
LAB FILE COPY
(4) Ship To ^ bdquo 4
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0 ANALYSIS LAB
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
M90-FTS 55
IMA 8872 bulllaquo PRO^
bullV INORGANICS TRAFFIC REPORT reg Case Number-
Sample Site NameCode
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Sampling Personnel
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Sample Description copy (Check One) Surface Water
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Solids Other
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0 SAMPLE MATRIX (Check One)
Water
(J) Shipping Information
Name Of Carrier
- fiflt^ Shipped
Airbil Nimher lt bdquo
(a) Mark Volume Level On Sample Bottle Check Analysis required
_L Task 1 amp 2 - Task 3 Ammonia
Sulfide Cyanide
TOC FlnnrHeamppH
LAB FJLE COPY
(4) Ship To
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(5) ANALYSIS LAB
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Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
)7-2490-FTS 5572490
IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
Sample Site NameCode
(cpound) Samplina Office
Sampling Personnel
(Name-)
(Phone) Sampling Date
(Beam) (End) r
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Sample Description copy (Check One) bdquo Surface Water
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Low CoiicenlidLion
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Water
0 Shipping Information
Name Of Carrier - - tx
Datp Shipper)
Airhill Niimhfir bdquo
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_ Task 1 amp 2 Task 3 Ammonia
Sulfide Cyanide
TOC T - - Fluoride amp pH
LAB FILE COPY
0 Ship To ft
shy bull
Attn
Transfer Ship To
0 ANALYSIS LAB
PPCT) by -
DatfiRfirH l
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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(Check One) Sample Site NameCode Luw Cuiiceiilidliua
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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Name Of Carrier
Date Shipped
Airbill NiimhfiT
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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ExtractionPreparation (Acid)
ExtractionPreparation (Pesticides) tf
ExtractionPreparation (Dioxins)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation
ExtractionPreparation(Dioxins) QC
Preparation (VOA)QC
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BaseNeutral
Acid
Pesticides
Dioxins
VOA
Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
QC(VOA)
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ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
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Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
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BaseNeutral
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Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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M90-FTS 55
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
)7-2490-FTS 5572490
IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
(5) Sampling Office
Sampling Personnel
(NflTTiegt)
(Phone) Sampling Date
(Begin) (End)
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Low Concentration
0 SAMPLE MATRIX (Check One)
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(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
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LAB FILE COPY
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
SB- ^ INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Water
(e) Shipping Information Name Of Carrier
Datlt=gt Shipped
Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
Sulfade Cyanide
fnr FlnnnHoamppH
LAB FILE COPY
Sample Number
IMA 8876
() Ship To
Attn
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0 ANALYSIS LAB
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Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO Bo
IA 8877 INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
(2) SAMPLE CONCENTRATION (Check One)
Low ConceuUdhun
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Name Of Carrier
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_____ Solids Oth mshy
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(a) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammnnifl
Sulfide Cyanide
Tor1
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LAB FILE COPY
(T) Ship To
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Transfer Ship To
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RwH Vy f i
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bull bull - raquo bull
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
rub^vcU Alexandria VA22313 703 557-2490-FTS 5572490 IMA SSTS PRddeg INORGANICS TRAFHC REPORT
0 SAMPLE CONCENTRATION reg Case Number (Check One) Sample Site NameCode
1 LuW CoilUtillLldtlOll
0 SAMPLE MATRIX (Check One)
Water _ SoilSedimpnt
(5) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
(Phone) Datfi Shipped Sampling Date
Airbill MiimhfiTshy
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Sample Description (J) Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required fiTrgtunH Watdegr
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MATPHRS ORGANIC SAMPIR MO --
LAB FILE COPY
0 Ship To
Attn
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Acid
Pesticides
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Complete section below only if sample is used for duplicate or spike analyses
QC (BaseNeutral)
QC (Acid)
QC(Pesticides)
QC (Dioxins)
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ExtractionPreparation(Acid)QC
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Preparation(VOA)QC
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QC (Acid)
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
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copy For each sample collected sp ecify number (n) AnalysisLab bullbull of containers used and mark volume level on each bottle Date RACU- 7^5SJ
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Containers Total Volume ice Chain-of-Custody etc)
Water (Extractable) a I11
Water (VOA) 2 ^lt
SoilSediment
Water (ExtVOA)
Other
copy Sample Location
Mixed Media
Solids
Other (specify)
copy Special Handling Instructions (eg safety precautions hazardous nature)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office IO I- bullbullbullbull c bullbull Agtxlaquoina Vnyimu22313 703 S57 2490 bullIV1 gt7 2490 Sample Number i ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
(laquoraquo Mr Dfisignate helow QC
T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
y Water
(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
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Attn
Transfer Ship To
0 ANALYSIS LAB
Perrj by
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Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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(Check One) Sample Site NameCode Low ConctJiiUdlion
0 SAMPLE MATRIX (Check One)
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Sampling Personnel Name Of Carrier
(Name)
(Phone) - - Dfltfi Shipper Sampling Date
Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
Task 3 Ammonia
Sulfide __^_ Solids Cyanide Oth sr TOf1
(specify) ^_ Fluoride amp pH
MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
0 Ship To - gt
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0 ANALYSIS LAB
Rerrt hy ^
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Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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Sample Site NameCode
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(Name)
(Phone) Sampling Date
(Beam) _ - (End)
Sample Description copy (Check One) bdquo Surface Water
_fc^mdash Ground Water
____ Solids nth^r
(specify) MATCHES ORGANIC SAMPLE NOshy
0 SAMPLE CONCENTRATION (Check One)
Low Conctjnlidliun
0 SAMPLE MATRIX (Check One)
mdash Water
(T) Shipping Information Name Of Carrier
- raquo
Datp SViipppfi
Airhill Niimher
0 Mark Volume Level On Sample Bottle Check Analysis required
_raquopound Task 1 amp 2 Task 3 Ammonia
Sulhde Cyanide
TOC J_- _ FluondeamppH
LAB FILE COPY
(4) Ship To ^ bdquo 4
- 11 bull i
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0 ANALYSIS LAB
PPI-H -vy r
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
M90-FTS 55
IMA 8872 bulllaquo PRO^
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Sample Site NameCode
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Sample Description copy (Check One) Surface Water
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Solids Other
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MATCHES ORGANIC SAMPLE NOmdashimdash mdashgtshy
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0 SAMPLE MATRIX (Check One)
Water
(J) Shipping Information
Name Of Carrier
- fiflt^ Shipped
Airbil Nimher lt bdquo
(a) Mark Volume Level On Sample Bottle Check Analysis required
_L Task 1 amp 2 - Task 3 Ammonia
Sulfide Cyanide
TOC FlnnrHeamppH
LAB FJLE COPY
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(5) ANALYSIS LAB
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Sample Condition On Receipt
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
)7-2490-FTS 5572490
IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
Sample Site NameCode
(cpound) Samplina Office
Sampling Personnel
(Name-)
(Phone) Sampling Date
(Beam) (End) r
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Sample Description copy (Check One) bdquo Surface Water
(Ground Wfltor
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(specify) MATCHES ORGANIC SAMPLE NO
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0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier - - tx
Datp Shipper)
Airhill Niimhfir bdquo
(J) Mark Volume Level On Sample Bottle Check Analysis required
_ Task 1 amp 2 Task 3 Ammonia
Sulfide Cyanide
TOC T - - Fluoride amp pH
LAB FILE COPY
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Transfer Ship To
0 ANALYSIS LAB
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Sample Condition On Receipt
(eg broken leakage chain of custody etc )
J -1
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sampling Personnel Name Of Carrier
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Sulfide Solids Cyanide OtVmr
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
(5) Sampling Office
Sampling Personnel
(NflTTiegt)
(Phone) Sampling Date
(Begin) (End)
Sample Description copy (Check One) Si irface Wat^r
Ground Wfltor
Solids Othpr
(specify) MATCHES ORGANIC S AMPT K NO
0 SAMPLE CONCENTRATION (Check One)
Low Concentration
0 SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
Sulfide Cyanide
TOC _-_ Fluoride amp pH
LAB FILE COPY
0 Ship To
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Transfer Ship To
0 ANALYSIS LAB if
Ro^hy H
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Sample Condition On Receipt
(eg broken leakage chain of custody etc ) I
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US ENVmONMENTAL PROTECTION AGENCY HWI Sample Management Office M90-FTS 5572490
SB- ^ INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Sampling Personnel
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(Phone) Sampling Date
(Beoin) (End)
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Surf tiro WatPT f-JronnH W^t^r
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Low CuiiceiilidLiuii
0 SAMPLE MATRIX (Check One)
Water
(e) Shipping Information Name Of Carrier
Datlt=gt Shipped
Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
Sulfade Cyanide
fnr FlnnnHoamppH
LAB FILE COPY
Sample Number
IMA 8876
() Ship To
Attn
Transfer Ship To
0 ANALYSIS LAB
Rlaquov1hy bull mdash f 1 ^ i
DateRfirH
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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IA 8877 INORGANICS TRAFFIC REPORT reg Case Number
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(2) SAMPLE CONCENTRATION (Check One)
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Name Of Carrier
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_____ Solids Oth mshy
(specify) MATCHES ORGANICSAMPTF NO _ mdash
(a) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammnnifl
Sulfide Cyanide
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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0 SAMPLE CONCENTRATION reg Case Number (Check One) Sample Site NameCode
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0 SAMPLE MATRIX (Check One)
Water _ SoilSedimpnt
(5) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
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Airbill MiimhfiTshy
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Sample Description (J) Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required fiTrgtunH Watdegr
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Sulfide Solids Cyanide nthfir
TOG (specify) FliirHlaquo pH
MATPHRS ORGANIC SAMPIR MO --
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0 ANALYSIS LAB
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Sample Condition On Receipt
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Task 1 amp 2 Tank 3 Ammonia
Sulhde Solids Cyanide Other Tor (specify)
_ FtiirH^pH MATCHES ORGANIC S AMPT R NO _
LAB FILE COPY
(4) Ship To - 1 A
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(9) ANALYSIS LAB
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
reg Case Number Sample Site NameCode
(jj) Sampling Office
Sampling Personnel
(Name) -
(Phone) Sampling Date
(Beam) (End)
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_____ Solids OHi(=r
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SAMPLE CONCENTRATION (Check One)
Low CunceutidLiou
0 SAMPLE MATRIX (Check One)
Water SoilSedirnpnt
(e) Shipping Information
Name Of Carrier s
lt- i
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Airhill Niimhfir
(s) Mark Volume Level On Sample Bottle Check Analysis required
i_ Task 1 amp 2 Tsslf 3 Ammonia
Sulfide Cyanide
TOC Fl^^nHo laquor pH
LAB FILE COPY
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
INORGANICS TRAFFIC REPORT (T) Case Number
Sample Site NameCode
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Sampling Personnel
(Nflmp)
(Phone) Sampling Date
(Begin) (End)
copy Sample Description (Check One)
M Surface Water _ (Ground Wfltpt
Solids Othmshy
(specify)
MATCHES ORGANIC SAMPLE NO
SAMPLE CONCENTRATION (Check One)
Low Concentration
reg SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier f t flt f raquo - f
Dfltp Shipped
Airbil l NiimhRr
(a) Mark Volume Level On Sample Bottle Check Analysis required
^ Task 1 amp 2 _ Task 3 Ammnma
Sulfide Cyanide
TOG Jmdash- Fluoride amp pH
LAB FILE COPY
0 Ship To
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() ANALYSIS LAB
R0H hy f
DatfiRflcH i
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
(j Satnplina Office
Sampling Personnel
(Name) -
(Phone) Sampling Date
(Begin) (End) J shy
Sample Description copy (Check One) Surface Water
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Solids Othpr
(specify) MATCHES ORGANIC S AMPI K NO
SAMPLE CONCENTRATION (Check One)
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(5) SAMPLE MATRIX (Check One)
f Water
() Shipping Information
Name Of Carrier
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D^tfi RViippesfi t
Airhill Number
Q Mark Volume Level On Sample Bottle Check Analysis required
_L Task 1 amp 2 Task 3 Ammonia
Sulfide Cyanide
Tnr raquo__ FlnrHlaquo amp pH
LAB FILE COPY
(5) Ship To v^1 A
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() ANALYSIS LAB
TD u raquo A r lt pprrl hy
DateRttrH
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
SSJ IA 8883 INORGANICS TRAFnC REPORT 0 SAMPLE CONCENTRATION (T) Case Number _ bdquo 0 Ship To shy
(Check One) Sample Site NameCode f mdash Low Concentration ^
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(5) Sampling Office 0 Shipping Information 0 ANALYSIS LAB
Sampling Personnel Name Of Carrier it
Ror-H Ky - -
(Nam)
DatpR^rH C ^ ^(Phone) Datfi Shipped
Sampling Date Airlr1 Niirphfir shy
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Sample Condition On Receipt Sample Description (^ Mark Volume Level copy (Check One) On Sample Bottle (eg broken leakage chain of custody etc )
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Tflsk 3 Ammonia Sulfide Solids
OtW Cyanide
TOC (specify) L - Fluoride amp pH
MATCHES ORGANIC SAMPLE NO
LAB FILE COPY
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office IO I- bullbullbullbull c bullbull Agtxlaquoina Vnyimu22313 703 S57 2490 bullIV1 gt7 2490 Sample Number i ORGANICS LABORATORY CHRONICLE (EXTRACTIONS)
T^HN^TTifi 1 QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
Case No Designate below OC analysis selected Low Concentration
I h Sample TO No (If Applicable) Medium Concentration
QC RepoH- NO Duplicate SAMPLE MATRIX (Check One) _ laquolaquoAA
Matrix Spike HOV Olfltt Water SoilSediment
Description Technician Signature Detail Below Pertinent Information andor DateTime ExtractionPreparation Completed Problems Associated with ExtractionPreparation
ExtractionPreparation (BaseNeutral)
ExtractionPreparation (Acid)
ExtractionPreparation(Pesticides)
ExtractionPreparation (Dioxins)
Preparation(VGA)
bull f
Complete section below only if sample is to be used for duplicate or spike analyses
ExtractionPreparation(BaseNeutral) QC
ExtractionPreparation(Acid)QC
ExtractionPreparation(Pesticides) QC
ExtractionPreparation(Dioxins) QC
Preparation(VOA)QC
bullFBtCT| US ENVIRONMENTAL PROTECTION AGENCY HWISomi raquomdash degK~|mj|BTlaquolH P-O Box 8 1 8 Alexandria Virginia 223 1 3 -703 557-2490 -FTS 5575490
JB^JI ORGANICS LABORATORY CHRONICLE (j
T h Nmlaquo QC REQUIREMENTS SAMPLE CONCENTRATION (Check One)
(laquoraquo Mr Dfisignate helow QC
T ^Vgt Sample ID Noanalysis performed
(Tf Applicable) Low Concentration Medium Concentration
QT RlaquoraquoprtT+ Nn Hi mlirfltplaquo yenn SAMPLE MATRIX
Matrix Spike O t i
y Water
(Check One)
SoilSediment
D^Qr-rintion Analyst Signature Detail Below Pertinent Information andor DateTime Analysis Completed Problems Associated with Analysis
BaseNeutral
Add
Pesticides
Dioxins
VGA
Complete section below only if sample is used for duplicate or spike analyses
QC(BaseNeutral)
QC (Acid)
QC (Pesticides)
QC (Dioxins)
QC(VOA)
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office axels Alexc
INORGANICS TRAFFIC REPORT reg Case Number
Sample Site NameCode
Q Samolina Office
Sampling Personnel
(NfliTifgt)
(Phone) Sampling Date
(Beam) (End)
copy Sample Description (Check One)
Surface Water r Ground Water
__^_ Solids Othpr
(specify) MATCHES ORGANir SAMPLF NO
0 SAMPLE CONCENTRATION (Check One)
Low Cuuctmlidliuii
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier
-bull 5
Datp Rhippfirf-
Airbill NTnb(=gtr
(B) Mark Volume Level On Sample Bottle Check Analysis required
-_ Task 1 amp 2 Taltlf 3 Ammnrna
Sulfide Cyanide
TOC Fluoride amp pH
LAB FILE COPY
(4) Ship To
i
i k
Attn
Transfer Ship To
0 ANALYSIS LAB
Perrj by
DarfiRfirH- ~~
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
V
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
X^ ixxdi= Alexandra VA 22313 703 557 2490 -FTS 5572490 IMA 8870 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION reg Case Number
(Check One) Sample Site NameCode Low ConctJiiUdlion
0 SAMPLE MATRIX (Check One)
J Water
(jj) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
(Phone) - - Dfltfi Shipper Sampling Date
Airbill NiiTnh^ishy(Beoin) bdquo (End) k
Sample Description (ipound Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required (Ground Watpr
Tact 1 amp 9
Task 3 Ammonia
Sulfide __^_ Solids Cyanide Oth sr TOf1
(specify) ^_ Fluoride amp pH
MATCHES ORGANIC SAMPLE NO -t-ii
LAB FILE COPY
0 Ship To - gt
bulllt f t ~ J
Attn
Transfer Ship To
0 ANALYSIS LAB
Rerrt hy ^
DatfiRprH- ^
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
f f
Alaquopounddeg sgt US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office -2490 -F
INORGANICS TRAFnC REPORT ltT) Case Number gt
Sample Site NameCode
Q Samplina Office
Sampling Personnel
(Name)
(Phone) Sampling Date
(Beam) _ - (End)
Sample Description copy (Check One) bdquo Surface Water
_fc^mdash Ground Water
____ Solids nth^r
(specify) MATCHES ORGANIC SAMPLE NOshy
0 SAMPLE CONCENTRATION (Check One)
Low Conctjnlidliun
0 SAMPLE MATRIX (Check One)
mdash Water
(T) Shipping Information Name Of Carrier
- raquo
Datp SViipppfi
Airhill Niimher
0 Mark Volume Level On Sample Bottle Check Analysis required
_raquopound Task 1 amp 2 Task 3 Ammonia
Sulhde Cyanide
TOC J_- _ FluondeamppH
LAB FILE COPY
(4) Ship To ^ bdquo 4
- 11 bull i
Attn
Transfer Ship To
0 ANALYSIS LAB
PPI-H -vy r
natBRlaquofH- y
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
M bull
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
M90-FTS 55
IMA 8872 bulllaquo PRO^
bullV INORGANICS TRAFFIC REPORT reg Case Number-
Sample Site NameCode
(ji) Sampling Office
Sampling Personnel
(Nflmf)
(Phone)
Sampling Date
(Beam) (End)
Sample Description copy (Check One) Surface Water
f mdash Ground Water
Solids Other
(specify)
MATCHES ORGANIC SAMPLE NOmdashimdash mdashgtshy
SAMPLE CONCENTRATION (Check One) mdash Low Concentration
0 SAMPLE MATRIX (Check One)
Water
(J) Shipping Information
Name Of Carrier
- fiflt^ Shipped
Airbil Nimher lt bdquo
(a) Mark Volume Level On Sample Bottle Check Analysis required
_L Task 1 amp 2 - Task 3 Ammonia
Sulfide Cyanide
TOC FlnnrHeamppH
LAB FJLE COPY
(4) Ship To
jf S -J i jr
Attn
Transfer Ship To
(5) ANALYSIS LAB
R0nHhy ^^^
DateRfir-rf ^
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
^
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
)7-2490-FTS 5572490
IA 8873 INORGANICS TRAFFIC REPORT reg Case Numher
Sample Site NameCode
(cpound) Samplina Office
Sampling Personnel
(Name-)
(Phone) Sampling Date
(Beam) (End) r
f
Sample Description copy (Check One) bdquo Surface Water
(Ground Wfltor
__ Solids nthpr
(specify) MATCHES ORGANIC SAMPLE NO
0 SAMPLE CONCENTRATION (Check One)
Low CoiicenlidLion
0 SAMPLE MATRIX (Check One)
Water
0 Shipping Information
Name Of Carrier - - tx
Datp Shipper)
Airhill Niimhfir bdquo
(J) Mark Volume Level On Sample Bottle Check Analysis required
_ Task 1 amp 2 Task 3 Ammonia
Sulfide Cyanide
TOC T - - Fluoride amp pH
LAB FILE COPY
0 Ship To ft
shy bull
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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(e) Shipping Information
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QC (Acid)
QC (Pesticides)
QC (Dioxins)
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(J) Shipping Information
Name Of Carrier
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Airbil Nimher lt bdquo
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Sulfide Cyanide
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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(Name-)
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(Beam) (End) r
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0 Shipping Information
Name Of Carrier - - tx
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PPCT) by -
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
AJexandnc IMA 8874 INORGANICS TRAFFIC REPORT 0 SAMPLE CONCENTRATION (T) Case Number
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0 SAMPLE MATRIX (Check One)
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Sampling Personnel Name Of Carrier
A i (Name) J
(Phone) f DstB RmppeH t
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Ta=lr 1 K
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office 2490-ITS 557249C
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Sample Site NameCode
(5) Sampling Office
Sampling Personnel
(NflTTiegt)
(Phone) Sampling Date
(Begin) (End)
Sample Description copy (Check One) Si irface Wat^r
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(specify) MATCHES ORGANIC S AMPT K NO
0 SAMPLE CONCENTRATION (Check One)
Low Concentration
0 SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier
Date Shipped
Airbill NiimhfiT
(J) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Taslr 3 Ammnnia
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0 SAMPLE MATRIX (Check One)
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(e) Shipping Information Name Of Carrier
Datlt=gt Shipped
Airhill Niimhfir-
(Y) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammonia
Sulfade Cyanide
fnr FlnnnHoamppH
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Sample Number
IMA 8876
() Ship To
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0 ANALYSIS LAB
Rlaquov1hy bull mdash f 1 ^ i
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
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Sample Site NameCode
(2) SAMPLE CONCENTRATION (Check One)
Low ConceuUdhun
0 SAMPLE MATRIX fPViorlr Onal
Water
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(e) Shipping Information
Name Of Carrier
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(Phone) Sampling Date
(Beam) (End)
Date Shipped
Airhill Number-
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- SurfsrB Water Glround Writer
_____ Solids Oth mshy
(specify) MATCHES ORGANICSAMPTF NO _ mdash
(a) Mark Volume Level On Sample Bottle Check Analysis required
Task 1 amp 2 Task 3 Ammnnifl
Sulfide Cyanide
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LAB FILE COPY
(T) Ship To
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RwH Vy f i
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rub^vcU Alexandria VA22313 703 557-2490-FTS 5572490 IMA SSTS PRddeg INORGANICS TRAFHC REPORT
0 SAMPLE CONCENTRATION reg Case Number (Check One) Sample Site NameCode
1 LuW CoilUtillLldtlOll
0 SAMPLE MATRIX (Check One)
Water _ SoilSedimpnt
(5) Sampling Office 0 Shipping Information
Sampling Personnel Name Of Carrier
(Name)
(Phone) Datfi Shipped Sampling Date
Airbill MiimhfiTshy
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Sample Description (J) Mark Volume Level copy (Check One) On Sample Bottle Surface Water Check Analysis required fiTrgtunH Watdegr
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Sulfide Solids Cyanide nthfir
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Surfflrp Wator Check Analysis required f mdash Ground Water
Task 1 amp 2 Tank 3 Ammonia
Sulhde Solids Cyanide Other Tor (specify)
_ FtiirH^pH MATCHES ORGANIC S AMPT R NO _
LAB FILE COPY
(4) Ship To - 1 A
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
KG i^xdo Alexandria VA22313 703 557-2490-FTS 5572490 IMA 8880 INORGANICS TRAFFIC REPORT
reg Case Number Sample Site NameCode
(jj) Sampling Office
Sampling Personnel
(Name) -
(Phone) Sampling Date
(Beam) (End)
Sample Description copy (Check One) Surface Water OiroTinH Writer
_____ Solids OHi(=r
(specify) MATCHES ORGANIC SAMPLK MO
SAMPLE CONCENTRATION (Check One)
Low CunceutidLiou
0 SAMPLE MATRIX (Check One)
Water SoilSedirnpnt
(e) Shipping Information
Name Of Carrier s
lt- i
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Airhill Niimhfir
(s) Mark Volume Level On Sample Bottle Check Analysis required
i_ Task 1 amp 2 Tsslf 3 Ammonia
Sulfide Cyanide
TOC Fl^^nHo laquor pH
LAB FILE COPY
(T) Ship To
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office POBox818Alexc
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Sample Site NameCode
Q Samplina Office
Sampling Personnel
(Nflmp)
(Phone) Sampling Date
(Begin) (End)
copy Sample Description (Check One)
M Surface Water _ (Ground Wfltpt
Solids Othmshy
(specify)
MATCHES ORGANIC SAMPLE NO
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Low Concentration
reg SAMPLE MATRIX (Check One)
Water
(e) Shipping Information
Name Of Carrier f t flt f raquo - f
Dfltp Shipped
Airbil l NiimhRr
(a) Mark Volume Level On Sample Bottle Check Analysis required
^ Task 1 amp 2 _ Task 3 Ammnma
Sulfide Cyanide
TOG Jmdash- Fluoride amp pH
LAB FILE COPY
0 Ship To
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gt W ~ f b
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R0H hy f
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(eg broken leakage chain of custody etc )
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US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
PO boxdib Alexandria VA22313 703 557-2490-FTS 557 249G
IMA 8882 INORGANICS TRAFFIC REPORT reg Case Number lt
Sample Site NameCode
(j Satnplina Office
Sampling Personnel
(Name) -
(Phone) Sampling Date
(Begin) (End) J shy
Sample Description copy (Check One) Surface Water
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Solids Othpr
(specify) MATCHES ORGANIC S AMPI K NO
SAMPLE CONCENTRATION (Check One)
mdash Low Concentration
(5) SAMPLE MATRIX (Check One)
f Water
() Shipping Information
Name Of Carrier
_^
D^tfi RViippesfi t
Airhill Number
Q Mark Volume Level On Sample Bottle Check Analysis required
_L Task 1 amp 2 Task 3 Ammonia
Sulfide Cyanide
Tnr raquo__ FlnrHlaquo amp pH
LAB FILE COPY
(5) Ship To v^1 A
- ^ - bull
Attn
Transfer Ship To
() ANALYSIS LAB
TD u raquo A r lt pprrl hy
DateRttrH
Sample Condition On Receipt
(eg broken leakage chain of custody etc )
f
US ENVIRONMENTAL PROTECTION AGENCY HWI Sample Management Office Sample Number
557 2490-FTS 5572490
SSJ IA 8883 INORGANICS TRAFnC REPORT 0 SAMPLE CONCENTRATION (T) Case Number _ bdquo 0 Ship To shy
(Check One) Sample Site NameCode f mdash Low Concentration ^
-y - gt yen 0 SAMPLE MATRIX
(Check One) f Attn - Water
Transfer Ship To
(5) Sampling Office 0 Shipping Information 0 ANALYSIS LAB
Sampling Personnel Name Of Carrier it
Ror-H Ky - -
(Nam)
DatpR^rH C ^ ^(Phone) Datfi Shipped
Sampling Date Airlr1 Niirphfir shy
(Beam) (End)
Sample Condition On Receipt Sample Description (^ Mark Volume Level copy (Check One) On Sample Bottle (eg broken leakage chain of custody etc )
Burfarp Water Check Analysis required laquo GifounH Wfltpr - lt - Cs_i_ Task 1 amp 2
Tflsk 3 Ammonia Sulfide Solids
OtW Cyanide
TOC (specify) L - Fluoride amp pH
MATCHES ORGANIC SAMPLE NO
LAB FILE COPY
