2014-04-07_INSPECTION - M1985210

• Permit No: M1985210
• IBM Index Class Name: INSPECTION
• Doc Date: 4/7/2014
• Doc Name: Soil Sampling & analytical results
• From: Palmetto Environmental Group, LLC
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

PaceAna/yh' cal
�v pacatabs V( '
Client Name: l/ ytrf-
Courier: Fed Ex ❑ UPS ❑ USPS ❑ Client ❑ Commercial 1 1 Pace C 1
Tracking #: Pace Shipping Label Used?
Custody Seal on Cooler /Box Present: Yesz No ❑ Seats intact: Yes/
Packing Material: Bubble
ap ❑ Bubble Bags /Foam CI
J-2-399 )/
Thermometer Used: T-194 Tvoe of Ice: 69 Blue Nc
WO #60165959
11 � 1111111111111111111
tional
Other Vii roj Due Date:
Yes LI No'CJ :)roj Name:
No ❑
None ❑ Other �Z0P/G
ne U Samples receive /d on ice, coolinq process has begun.
Cooler Temperature:
(circle one)
�ontents, a and ini ' a f 1q� xamining
T Z ` ►('
7em erature should be above freezing to 6°C
Chain of Custody resent:
Yes
❑ No
❑ N /A.
1,
Chain of Custody filled out:
tl Yes
❑No
❑N/A
2.
Chain of Custody relinquished:
Yes
El No
11 N/A
3.
Sampler name & signature on COC:
es
❑No
❑N/A
Samples arrived within holding time:
es
❑No
❑N /A
5.
Short Hold Time analyses <721 :
OYes
No
❑NIA
6.
Rush Turn Around Time requested:
As
❑No
❑N /A
7.
Sufficient volume:
11No
I IN /A
8.
/Yes
orrect containers used:
Y.
(
El No
❑N /A
Pace containers used:
AS
❑No
El NIA
9.
Containers intact:
Yes
❑No
❑N/A
10.
n reserved 5035A soils frozen w /in 48hrs?
❑Yes
❑No
AIA
11.
filtered volume received for dissolved tests?
[]Yes
F1
NIA
12.
Sample labels match COC:
Yes
❑No
❑N /A
L
Includes date/time/ID/analyses Matrix:
13.
II containers needing preservation have been checked
❑yes
❑No
NIA
II containers needing preservation are found to be in
[IYeS
/11,
[IN. /NA
compliance with EPA recommendation.
14.
Initial when
Folt of added
xce otions VOA, coliform, TOG 0 &G, WI -DRO (water)
❑es
henolics
o
ervative
rip Blank present.
❑Yes
❑No
NIA
Pace Trip Blank lot # if purchased):
15.
Headspace in VOA vials ( >6mm):
❑Yes
ONO
NIA
16.
Vroject sampled in USDA Regulated Area:
❑Yes
IX
LIN /A
117. List State.
Client Notification) Resolution
Person Contacted: _
Comments/ Resolution:
Project Manager Review
Copy COC to Client? / N Field Data Required? Y I N
Daterrime:
Date 'J V "t I 1
F -KS -C- 003 -Rev 7, 040eger4j�kf74a