Document N2J3jD7rrbzZmY5MQqLv6qBnp

Precise Research. Proven Results. Analytical Report Flubrochemical Characterization of Aqueous Samples Decatur Outfall 001 FC Monitoring (E05-0115) Exygen Research Laboratory Report No. L0004613 Testing Laboratory Exygen Research 3058 Research Drive State College, PA 16801 Project Lead Jess Eldrldge 3M Environmental Technology and Safety Services 935 Bush Avenue Building 0002-03-E-09 PO Box 33331 St. Paul, MN 55133-3331 exygen.com 1 Introduction Results are reported for the analysis of aqueous samples received by Exygen Research (Exygen) from PACE Analytical. The Exygen study number assigned to the project is L0004613. Specific fluorochemical characterization by liquid chromatography / tandem mass spectrometry (LC/MS/MS) was requested for all samples. A total of 8 samples (including field duplicates, blanks, and spikes) were received for analysis. The samples were prepared and analyzed by LC/MS/MS for the following list of fluorochemicals: Table 1: Target Analysis Compound Name Perfluorobutanesulfonate (PFBS) Perfluorohexanesulfonate (PFHS) Perfluorooctanesulfonate (PFOS) Perfluorobutvric Acid Perfluoropentanoic Acid Perfluorohexanoic Acid Perfluoroheotanoic Acid Perfluorooctanoic Acid Perfluorononanoic Acid Perfluorodecanoic Acid Perfluoroundecanoic Acid Perfluorododecanoic Acid Perfluorobutanesulfonamide (PFB Amide) Perfluorooctanesulfonamide 2-(N-methvloerluorobutanesulfonamido)ethvl alcohol Acronym C4 Sulfonate C6 Sulfonate C8 Sulfonate C4 Acid C5 Acid C6 Acid C7 Acid C8 Acid C9 Acid C10 Acid C11 Acid C12 Acid FBSA FOSA Me-FBSE-OH The analytical methods used were originally developed for groundwater samples and were validated by Exygen. The validation protocol and results are on file with Exygen. Only the C8 Sulfonate, FOSA, and C8 Acid were included in the original method validation. It should be noted that the quality control elements included in this analysis demonstrate the applicability of the method to the additional analytes. 2 Sample Receipt The water samples were submitted in plastic containers. Samples were received at ambient temperature. Samples were stored at 4C from receipt until analysis. Eight individual containers were received. Field samples were collected on 2/15/05 and 2/16/05. Samples were received on 2/17/05. Chain-of-custody information is presented in Attachment C. PAGE 2 OF 5 3 Holding Times Field and laboratory spikes of these fluorochemicals have shown stability for periods greater than 90 days. Samples were analyzed within 60 days of collection. 4 Methods - Analytical and Preparatory 4.1 LC/MS/MS 4.1.1 Sample Preparation for LC/MS/MS Analysis Water samples were initially treated with 200 uL of 250 mg/L sodium thiosulfate solution to remove residual chlorine. Solid phase extraction (SPE) was used to prepare the samples for LC/MS/MS analysis. A 40 mL portion of sample was transferred to a C18 SPE cartridge. The cartridge was eluted with 5 mL of 100% methanol. This treatment resulted in an eight-fold concentration of the diluted samples prior to analysis. 4.1.2 Sample Analysis by LC/MS/MS In HPLC, an aliquot of extract is injected and passed through a liquid-phase chromatographic column. Based on the affinity of the analyte for the stationary phase in the column relative to the liquid mobile phase, the analyte is retained for a characteristic amount of time. Following HPLC separation, ES/MS provides a rapid and accurate means for analyzing a wide range of organic compounds, including fluorochemicals. Electrospray is generally operated at relatively mild temperatures; molecules are ionized, fragmented, and detected. Ions characteristic of known fluorochemicals are observed and quantitated against standards. A Hewlett-Packard HP1100 HPLC system coupled to a PE Sciex API 4000 MS/MS was used to analyze the sample extracts. Analysis was performed using selected reaction monitoring (SRM). Samples were extracted on 2/21/05. Samples were analyzed on 3/9/05. Raw analytical data is provided in Attachment D. 5 Analysis 5.1 Calibration A 9-level calibration curve was analyzed at the beginning and throughout the analytical sequence for the compounds of interest. The calibration points were prepared at 0, 25, 50, 100, 250, 500, 1000, 2500, and 5000 ng/L (ppt) for LC/MS/MS analysis. The instrument response versus the concentration was plotted for each point. Using linear regression with 1/x weighting, the slope, y-intercept and correlation coefficient (r) and coefficient of determination (r2) were determined. A calibration curve is acceptable if r >0.985 (r2> 0.970). Calibration standards are prepared using the same SPE procedure used for samples. All calibration criteria were met for this analysis. 5.2 Blanks Extraction blanks were prepared and analyzed with every extraction batch of samples. The extraction blanks should not have any target analytes present at or above the concentration of the low-level calibration standard. For these samples, the extraction blanks were compliant. PAGE 3 OF 5 Instalment blanks In the form of clean methanol solvent were also analyzed after every highlevel calibration standard, and after known high-level samples. Again, the blanks should not have any target analytes present at or above the low-level calibration standard. For the samples presented here the instrument blanks are compliant. 5.3 Surrogates Surrogate spikes are not a component of the LC/MS/MS analytical methods. 5.4 Matrix Spikes Field and laboratory spikes were prepared using all compounds of interest. Field spikes were prepared by adding a measured volume of field sample to a container spiked with the target analytes by the laboratory prior to shipping containers for sample collection. Laboratory spikes consisted of aliquots of un-spiked field samples that were fortified at the laboratory at the time of extraction. Field blank spikes consisted of laboratory water fortified at the laboratory and shipped with the sample containers to the field and back to the laboratory for analysis. Laboratory control spikes (see section 5.6) are samples of laboratory water spiked at the time of extraction. Each type of spike provides information needed to assess analyte stability, extraction efficiency, and matrix effects that may impact analytical results. Matrix spike recoveries are given in Attachment B. Please see Section 5.7 for additional discussion of matrix spike recoveries. 5.5 Duplicates Field and laboratory duplicates were prepared for each field sample. Duplicate results are given along with the sample results in Attachment A. 5.6 Laboratory Control Samples For LC/MS/MS analyses, Milliq water was spiked with all compounds of interest at 100 and 500 ng/mL during each extraction set. All recoveries for all compounds were between 70 130% in each LCS. Results are given along with the raw data in Attachment D. 5.7 Statement of Accuracy Based on results of field spikes, laboratory fortified field samples, field blank spikes, and laboratory control spikes, the analytical accuracy of all analytes is 30% for all compounds with the following exceptions. Results for C4 Acid and C5 Acid should be considered as screening quality because of high and variable field and laboratory matrix spike recoveries. Results for the C12 Acid and C4 Sulfonate are accurate to 50%. The statements of accuracy are based on an overall evaluation of recoveries of field and laboratory spikes, field blank spikes and laboratory control spikes. 5.8 Data Summary Please see Attachment A for a detailed listing of the analytical results. Results are reported in parts per billion (ppb) (ng/mL). Please note that the limit of quantitation is 1.0 ng/mL for all compounds except MeFBSE-OH and C4 Acid, which have a quantitation limit of 4.0 ng/mL. 6 Data/Sample Retention Samples are disposed of one month after the report is issued unless otherwise specified. All electronic data is archived on retrievable media and hard copy reports are stored in data folders maintained by Exygen. PAGE 4 O F5 7 Attachments 7.1 Attachment A: Results 7.2 Attachment B: Matrix Spike Recoveries 8.3 Attachment C: Chain of Custody 8.4 Attachment D: Raw Analytical Data 9 Signatures T S i U Am Paul Connolly, Team Leader- LCM (7 j L fT ) ^ /io h n M. Flaherty, Vice-President Other Lab Members Contributing to Data Karen Risha Mark Neeley 3 /.s /v t5 Date Date PAGE 5 O F5 SECTION A Analytical ^ Report 1 Proven Results. Summary of Fluorochemical Residues in Outfall 001 Effluent for E05-0115 Sample ID Decatur Outfall 001 79448 Decatur Outfall 001 79448* Decatur Outfall 001 79449 . Equipment Blank Field Blank C4 Acid** Perfluorobutyric Acid 88.7 85.1 92.4 ND ND Analyte Found (ng/mL) C5 Acid C6 Acid Perfluoropentanoic Acid Perfluorohexanoic Acid 3.68 8.87 3.53 3.65 ND 8.26 8.52 ND ND ND C7 Acid Perfluoroheptanoic Acid 3.45 3.36 3.47 ND ND Sample ID Decatur Outfall 001 79448 Decatur Outfall 001 79448* Decatur Outfall 001 79449 Equipment Blank Field Blank C8 Acid Perfluorooctanoic Acid , 12.9 11.7 12.0 ND ND, Analyte Found (ng/mL) C9 Acid C10 Acid Perfluorononanoic Acid Perfluorodecanoic Acid ND ND ND ND ND ND ND ND ND ND C11 Acid Perfluoroundecanoic Acid ND ND ND ND ND Sample ID Decatur Outfall 001 79448 Decatur Outfall 001 79448* Decatur Outfall 001 79449 Equipment Blank Field Blank C12 Acid Perfluorododecanoic Acid ND , ND ND ND ND Analyte Found (ng/mL) C4 Sulfonate C6 Sulfonate Perfluorobutanesulfonate Perfluorohexanesulfonate 57.0 58.2 4.20 3.97 55.7 4.25 ND ND ND ND C8 Sulfonate Perfluorooctanesulfonate 18.3 17.7 18.3 ND ND Analyte Found (ng/mL) Sample ID Decatur Outfall 001 79448 Decatur Outfall 001 79448* Decatur Outfall 001 79449 Equipment Blank Field Blank FBSA 37.2 35.9 38.3 ND ND FOSA 3.33 3.26 3.43 ND ND Me-FBSE-OH** 4.27 4.36 4.35 ND ND ND = Not detected = Response between 0 and 1 ng/mL. **ND = Not detected = Response between 0 and 4 ng/mL. ` Laboratory Duplicate 000 <,#^ Lm3s30t0Sa55tat8fteRCeosleleargceh, Drive PA 16801, USA V,T: 814.272.1039 F: 814.231.1580 exygen.com SECTION B Proven Results. Recovery Summary of Fluorochemical Residues in Outfall 001 Effluent for E05-0115 Sample Description Outfall 001 Low Flald Spika Outfall 001 High Fittld Spike Amount Spiked (ng/mL) C4 Acid*______________________ C5 Acid_______________________ C6 Acid_______________________ C7 Acid Amt Found Amount Amt Found Amount Amt Found Amount Amt Found Amount in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery (ng/mL) (ng/mL) (%> (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%) 10 88.7 118 ** 3.68 41.2 412 8.87 17.2 83 3.45 13.0 96 250 88.7 ,940 341 3.68 933 373 8.87 285 110 3.45 270 107 Outfall 001 S p k C Low Lab Spike Outfall 001 Spk D High Lab Spike Field Blank Low Field Spike Field Blank High Field Spike 500 10 250 88.7 88.7 ND ND 87.2 2260 10.5 183 ** 434 1.05 73 3.68 3.68 ND ND 8.74 1780 11.2 158 506 356 112 63 8.87 8.87 ND ND 10.1 607 11.7 252 * 120 117 101 3.45 3.45 ND ND 4.50 482 10.6 214 105 96 106 86 Sample Description Outfall 001 Low Field Spike Amount Spiked (ng/mL) C8 Acid C9 Acid C10 Acid C11 Acid Amt Found Amount Amt Found Amount Amt Found Amount Amt Found Amount in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery (ng/mL) (ng/mL) (/.) (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%) 10 12.9 21.2 83 ND 9.82 98 ND 9.18 92 ND 8.48 85 Outfall 001 High Field Spike 250 12.9 289 110 ND 269 108 ND 255 102 ND 243 97 Outfall 001 Spk C Low Lab Spike 1 12.9 14.5 ** ND 1.23 123 ND 1.17 117 ND 1.16 116 O u tfa ll 001 S p k O High Lab Spike 500 12.9 518 101 ND 516 103 ND 528 106 ND 559 112 Field Blank Low Field Spike 10 ND 10.0 100 ND 10.8 108 ND 11.8 118 ND 12.1 121 Field Blank High Field Spike 250 ND 224 90 ND 233 93 ND 237 95 ND 261 104 ND = Not detected = Response between 0 and 1 ng/mL. *ND - Not detected = Response between 0 and 4 ng/mL. J ^ 3 300558i Research Drive > r^ k s tSataite College, PA 16801, USA VT: 800.281.3219 F: 814.272.1019 exygen.com Proven Results. Recovery Summary of Fluorochemical Residues in Outfall 001 Effluent for E05-0115 Continued Sample Description Outfall 001 Low Field Spike Amount Spiked (ng/mL) C12 Acid C4 Sulfonate C6 Sulfonate C8 Sulfonate Amt Found Amount Amt Found Amount Amt Found Amount Amt Found Amount in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) <%) 10 ND , 7.75 78 57.0 75.2 * 4.20 15.8 116 18.3 26.0 77 Outfall 001 High Field Spike 250 ND 416 166 57.0 531 190 4.20 283 112 18.3 251 93 Outfall 001 Spk C Low Lab Spike 1 ND 1.29 129 57.0 59.9 ** 4.20 5.31 ** 18.3 19.3 ** Outfall 001 Spk D High Lab Spike 500 ND 982 \ 196 57.0 865 162 4.20 481 95 18.3 457 88 Field Blank Low Field Spike 10 ND 10.4 14 ND 12.7 127 ND 9.74 97 ND 10.2 102 Field Blank High Field Spike 250 ND 193 77 ND 159 64 ND 236 94 ND 252 101 Sample Description Outfall 001 Low Fiald Spike Amount Spiked (ng/mL) FBSA FOSA Me-FBSE-OH* Amt Found Amount Amt Found Amount Amt Found Amount in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery (nq/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%) 10 37.2 45.0 78 3.33 , 15.2 119 4.27 16.9 126 Outfall 001 High Field Spike 250 37.2 323 114 3.33 334 132 4.27 314 126 Outfall 001 Spk C Low Lab Spike 1 37.2 37.9 ** 3.33 4.88 155 4.27 8.47 ** O u tfa ll 001 S p k D High Lab Spike 500 37.2 538 100 3.33 664 \ 132 4.27 526 104 Field Blank Low Field Spike 10 ND 11.4 114 ND 11.2 112 ND 10.3 103 Field Blank High Field Spike 250 ND 247 99 ND 229 92 ND 250 100 ND = Not detected = Response between 0 and 1 ng/mL. *ND = Not detected = Response between 0 and 4 ng/mL. "S a m p le residue exceeded the spiking level by more than 4 times; therefore an accurate recovery cannot be calculated. 00 J& 3300558t Research Drive ir m s tSatatte College, PA 16801, USA VT: 800.281.3219 F: 814.272.1019 exygen.com SECTION C 3058 Research Drive State College, PA 16801 H Phone: 814-272-1039 Fax: 814-231-1580 I L o a in Login G roup: L0004613 Login #: Project: Company Name: Submitted By: Login Type: 4723 P0000689 3M Jess Eldridge Immediate Receipt of Samples Conform COC Sample: Conform COC: Conform Sample: Conform Request: False True True True Started: True Date Start: 02/17/2005 Due Date: 03/19/2005 Received Date: 02/17/2005 Received By: Edwards, Eric Spread Sample: Label: Exygen SD/PI: Risha, Karen Project Title/Type: Decatur Outfall 001 FC Monitoring / ROUTINE Login Notes: Conform Notes: Some of the samples received were not noted on the COC Record, so as per Shawn Robb Exygen added them to the COC Record. Th samples added are: Decatur Outfall 001 Travel Blank High Spike 250ppb. Decatur Outfall 001 Travel Blank Low Spike 10ppb. Decatur Outfall 001 Low Spie 10ppb. Decatur Outfall 001 High Spike 250ppb. EWE 2/17/05 Packaae PK0005460 Carton Date / Condition Packages / Containers ShiDDer/ ID Login Date: 2/17/2005 4:43:51PM Package & Contents Uncompromised FEDEX 850479486707 TemD. Control/TemD. None 22.3 Direction / Handled Bv RECEIVED Edwards, Eric Container # C0061902 C0061903 C0061904 C0061905 C0061906 C0061907 C0061908 C0061909 Gross Weiaht dH Container TvDe 618.10 g 500 ml Clear Plastic Narrow 258.10 g 500 ml Clear Plastic Narrow 619.30 g 500 ml Clear Plastic Narrow 613.40 g 500 ml Clear Plastic Narrow 255.90 g 500 ml Clear Plastic Narrow 255.80 g 500 ml Clear Plastic Narrow 228.90 g 500 ml Clear Plastic Narrow 228.50 g 500 ml Clear Plastic Narrow Preservative NONE NONE NONE NONE NONE NONE NONE NONE Mfa. Lot Mfa. ID 2/17/2005 Login.rpt Report Version: Feb 16 2005 11:02AM Page 1 of 2 Instance: R0147364 R0147364 Samde ID L0004613-0001 L0004613-0002 L0004613-0003 L0004613-0004 L0004613-0005 L0004613-0006 L0004613-0007 L0004613-0008 Container C0061902 C0061903 C0061904 C0061905 C0061906 C0061907 C0061908 C0061909 Matrix LIQUID LIQUID LIQUID LIQUID LIQUID LIQUID LIQUID LIQUID Login Fraction Water Samples Sample Decatur Outfall 001 Equipment Blank 79451 Date SamDled Date Loaaed In Date Due 02/17/2005 03/19/2005 Water Decatur Outfall 001 Travel Blank 79450 02/17/2005 03/19/2005 Water Decatur Outfall 001 79448 02/17/2005 03/19/2005 Water Decatur Outfall 001 Duplicate 79449 02/17/2005 03/19/2005 Water Water Water Decatur Outfall 001 Travel Blank High Spike 250ppb Decatur Outfall 001 Travel Blank Low Spike 10 PPb Decatur Outfall 001 Low Spike 10ppb 02/17/2005 03/19/2005 02/17/2005 03/19/2005 02/17/2005 03/19/2005 Water Decatur Outfall 001 High Spike 250ppb 02/17/2005 03/19/2005 Login Reviewed By: ^ 6 ________________________________________ Date/Time: _______ / 7 2/17/2005 Login.rpt Report Version: Feb 16 2005 11:02AM Page 2 of 2 Instance: R0147364 R0147364  USAirbill Express 1 From Date aLlLUiw fl5047c14flfci7Q7FedEx Tracking Number '-r*~-y- 's 'jvi,? Sf X _ Phone 7 * ^ < ; 3 7 - o y s - U Company Pace U u L iv W k Address___________ V m ^ C A } * t f . S u i~ t? /O O * Dapt/Floor/Suita/Room City ~1 M v C i ' ^ V S V \ l W __________State A y C / ZIP <-} S 0 7 ^ 0 ^ 2 Your Internal Billing Reference 3 To Name jjiy .J o h n Phone 9 o o S t*) Company Recipient's i Address We cannot detiver to PO. boxas or P.0. ZIP codes. Address 30S ^ 1? e ^ e g ic ^ To request a package be held at a specific FedEx location, print FedEx address here. City C~ h X 7 Co Hscj e P AState ZIP Dept/Ftoor/Suite/Room / 3 ) ? 6 / ^ iifc i 'j 4a Express Package Service /FedEx Priority Overnight " *xt business morning* I I FedEx Standard Overnight 1-- I Next business afternoon* u m as. I 1 FedEx First Overnight I-- ' Earliest next business rooming deliveryto select locations* ( i FedEx 2Day I-- )1 Second business d.ay* I I FedEx Express Saver 1--I-- II TThhirirddbbuussinineessssddaayv** FedEx Envelope rate not available. 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Q ? n y O ./# 8/'?/tT S A M P LE R NAM E A N D S IG N A T U R E PRINT Name of BAMPtFR SIGNATURE of SA SEE REVERSE DATE Signed: (MM / pD / YY)y <=5, FOR INSTRUCTIONS Form COC01 Rev. 0304 r ^ :h Instructions for completing Chain of Custody (COC) 1. Complete all Client Information at top of sheet: name, address, phone, contact (person to whom report will be sent and contact can be made if questions! arise),.billing information if different from client, PO#, Project Name and/or Project Number as it will appear on the report. 2. Quote Reference, Project Manager, Project No. and Profile No. will be completed by Pace. 3. A separate COC must be filled out for each day of sample collection. 4. Sampler should print their name in,the space provided and sign their name followed by the date of the sampling event. A, . . ' - ' - 5. Complete Sample Description as it will appear on the laboratory report; include time of sampling, sample matrix, no. of containers and preservative used. - , . > 6. 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A ll relevant fields must be completed accurately. *** Section B S ElJtify To Be Completed by Pace Analytical and Client Quote Reference: Section C Project Manager: . A Project #: h <. 7 f~ _____________ n li< r Profile #: SAMPLE CONDITION Temp in C Received on Ice Y/N SAMPLE NOTES C kloti**- ;/i / G r q b -s. O >o 'S Sealed Cooler Y/N C J t io T ( * e . (try tounposrti. " Sam ples Intact Y/N Additional Comments: CIa I ^ -- < ns-<a, ( d> r + (? Z 2 (% * ` OC I f, - >i, I C j/. 'Ur o. oc? O./O /iL S A M P LE R NAM E A N D S IG N A TU R E PRINT Name of SAMPLER: SIGNATURE of SAMPI 1b e t/ DATE Signed: (MM / DD / YY) , SEE REVERSE FOR INSTRUCTIONS Form COC01 Rev. 0304 JC i s - r ;) ;! \ V' ; K>.' , N "1 -:. 'V.?3 \ V' 11 , \ > Instructions for completing Chain of Custody (COC) ` 1, Complete all Client Information at top of sheet; name, address, phone, contact (person to whom report will be sent and contact can be made if questions afise^bHling information if different from client, PO#^Project Name and/or Project Number as it will appear on the report. 2. Quote Reference, Project Manager, Project No. and Profile No. will be completed by Pace. \ . ' , ' : ; V; : . C I :i J N K A 1 3. A separate COC must be illed out for each day of sample collection. o. 4 . Sampler should print their pjame the sampling event. .- . : 1 the space provided and sign their name followed by the date of-r ' ` _ '` _ _ ; " ' ' v- ' ' --' ` ' n ' ':* ; % ' 4 A i> J . : i . 5. Complete:Samp!e Descriplipn as it will appear on the laboratory report-; include time of sampling, / sample mafriXi no. of containers and preservative used. ' ,, . .: 1 ; ; , ;! . : : . ;, I 6. 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(Use Additional Comments Section,)':. , . , , . . .- **** - ' t ; A :rikB a :; w , - W -M A ydc&Analyticar / www.RiMlafct.cwn Required C lie n t Inform ation: Company 3m & Address Section A T Vss CHAIN-OF-CUSTODY / Analytical Request Document The Chain-of-Custody is a LEGAL DOCUMENT. A ll relevant fields m ust be completed accurately. N Required C lie n t Inform ation: Section B 857051 go ff.Report To: T** lpg t ot / To Be Completed by Pace Analytical and Client Copy To: N Client Information (Check quote/contract): Quote Reference: Invoice To: Requested Due Date: *TAT: Project Manager: . P.O. Project Name: h o r x . >L. N / t o + u . o o I Turn around time less than 14 days subject to laboratory and contractual obligations and may result in a Rush Turnaround Surcharge. 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Instructions for completing Chain of Custody (COC) 1 Complete all Client Information at top of sheet; name, address, phone, contact (person to whom report will be sent and contact can be made if questions, arise), billing information if different from client, PO#, Project Name and/or Project Number as it will appear on the report. 2. Quote Reference, Project Manager, Project No. and Profile No. will be completed by Pace. 3. A separate COC must be filled out for each day of sample collection. 4. Sampler should print their name in the space provided and sign, their name followed by the date of- the sampling event. , ,_ : 5. Complete Sample Description as it will appear on the laboratory report; include time of sampling, sample matrix, no. of containers and preservative used. . 6. Analysis Requested: Complete analysis on the lines provided and place a check in the column for the samples requiring the analysis. It may be necessary to use the space provided for additional comments or include attachments for extended lists of parameters. 7. Submission of samples to laboratory: Indicate Item Number of those samples being transferred; sign relinquished by, and include your affiliation. : * IMPORTANT NOTE: Standard Turnaround Time is 2 weeks. If this does not satisfy your requirements, arrangements must be made prior to samples being submitted to the laboratory. Contact your project manager. Special Project Requirements such as Low Level Detection Limits or level of QC reported must be indicated on the chain of custody. (Use Additional Comments Section.) % 3 ? w: s/t : vceAnalyticar / ww.piclaks.eaitt Required C lien t Inform ation: Section A Company Address 3m t-T d s s Phone N Fax Required C lien t Inform ation: Report To: KH,. T ris Copy To: Invoice To: P.O. Project Name: b Project Number: CHAIN-OF-CUSTODY / Analytical Request Document The Chain-of-Custody is a LEGAL DOCUMENT. Afi relevant fields must be completed accurately. N Section B . 857051 s EU,-,Af page: / of / Client Information (Check quote/contract): Requested Due Date: To Be Completed by Pace Analytical and Client Quote Reference: Section C Project Manager: . s ooi "Turn around time less than 14 days subject to laboratory and contractual obligations and may result in a Rush Turnaround Surcharge. Turn Around Time (TAT) in calendar days. tT r*/ t . ; T Project #: * _____________ Profile #: " _ O li' Section D Required C lie n t Inform ation: SAMPLE ID One character per box (A-Z, 0-9 / .- ) , Sample I M U S T BE UNIQUE L op $ A ' M iYl l + U t. CO Valid Matrix Codes MATRIX DRINKING WATER GROUNDWATER SURFACE WATER WASTE WATER PRODUCT SOIL OIL WIPE * ' AIR OTHER CODE DW GW SW WW P gC'*~ OL WP AR OT d 8 UiO i i II 0 n fn tr S:S i<'T\. aj 30 * f* s k' o s / / / S ' D ijl & _ Oe U M il i * 1m l l i i 1 ^ If .0 0 i t L ii'4 l 1 $ 1 J, . Jl I j j l T> M. ? 4-, mi im o '> ) i V Q U HO fluoS L U u C o l -vtpl t l i ^ i ili C Ho / V L Xiikr A C. / ( ' iL )h)i \ A 5 / / Y k e H iH i. -A >. - % --tsr- Preservatives H Rem arks / Lab ID I 7W - " f -/ Jk. *** SITE LOCATION NC SC GA Other-__:_____ REGULATORY AGENCY NPDES GROUND WATER DRINKING WATER UST RCRA Other_________ SAMPLE CONDITION SAMPLE NOTES Temp in C Received on Ice Y/N C A to t 1ft < . i* \ 1 Sealed Cooler Y/N Samples Intact Y/N C iifo /r e C in ta * in f; ft ~ C rm o 0 . 0 Ct H i K ' .1/ h r qnm iim RELINQUISHED BY / AFFILIATIOONN I DATE I TIME | ACCEPTED IBY / AFFILIATION A l^U . . VJ ft - cP ^ - - DATE TIME SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER:^ . "S SIGNATURE of SAMPLER: - 4 - i , I'h & v DATE Signed: (MM / DD / YY) , . ---1i, .. L H o SEE REVERSE SIDE FOR INSTRUCTIONS A J' '* Form CC01 Rev. 0304 Instructions for completing Chain of Custody (COC) 1. Complete all Client information at top of sheet: name, address, phone, contact (person to whom report will be sent and contact can be made if questions* arise),'.billing infQrmation if different from client, PO#, Project Name and/or Project Number as it will appear on the report. 2. Quote Reference, Project Manager, Project No. and Profile No. will be completed by Pace. 3. A separate COC must be filled out for each day of sample collection. 4. Sampler should print their name in the space provided and sign their name followed by the date of the sampling event. ' J ' " ' . ) ' " 5. Complete Sample Description as it will appear on the laboratory report; include time of sampling, sample matrix, no. of containers and preservative used. : - v > 6. Analysis Requested: Complete analysis on the lines provided and place a check in the column for the samples requiring the analysis. It may be necessary to use the space provided for additional comments or include attachments for extended lists of parameters. 7. Submission of samples to laboratory: Indicate Item Number of those samples being transferred; sign relinquished by, and include your affiliation. * IMPORTANT NOTE: Standard Turnaround Time is 2 weeks. If this does not satisfy your requirements, arrangements must be made prior to samples being submitted to the laboratory. Contact your project manager. Special Project Requirements such as Low Level Detection Limits or level of QC reported must be indicated on the chain of custody. (Use Additional Comments Section.) >f ,