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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: _n.L' M L- X . ti-rc . Workorder No: /~n t / t7 ~O ~ =~ <br />Project Manager: t ~,~, >°kt~~.,~Y Initials: /y~,> Date: ~ 7('~`~ <br />Additional Information: <br />ti~ <br />Was the laharatory du•ected to proceed with the analysis of any samples yielding dte presence of residual chlorine? YES 1 NO / NA <br />r14TE: <br />No pH adjustments strall be made without prior consent of Project Manager. After pH adjustments, hold metals <br />and radchem samples 216 hrs. before analysis. <br />Was the pH of any sample adjusted by the laboratory? YES (See Table below) / NO <br />pH Excursion• <br /> <br />Sample ID <br />Client ID <br />Initial pH <br />Final pH <br />RUs~ volume <br />Added <br />~~) <br />IAA °' ° <br />~ <br />> <br />Initials! Dale /Time <br />0 0 0 ~- t - P.+ 1~ HNtl 3 q~'y`I Mti~.lr i`~ ~}~:~ay /sao <br />tlJ c'Sa -t C P.+ I.2, ~-I tli~, 1O 41~`I ruttk•~ ~ } i av t5a0 <br /> <br /> <br /> <br /> <br /> <br /> <br />If applicable, was ttre client contacted? YES / NO / ~Cli/Ien[IIRep(.JName: <br />Project Manager Signature/Date: ~1``l~-f <br />Form 201r18.x15 (0128104) <br />Date/Time: <br />Page ~ of ~ <br />