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Paragon Ana/ytics CONDITION OF SAMPLE UPON RECEIPT FORM Client: ~;~ ti{ ~ nk ,1 .,c , Workorder No: ^ n t-~ O ~ ~~ 3 Project Manager: ~-or-i ft,~t,~.c,,,,,--_ Initials: C./t~-~ Date: ~ 2-ar/ 1, Does this project require any special handling in addition to standard Paragon procedures? YES ~O~ z. Is pre-screening required per SOP 008? YES NO 3. Are custody seals on shipping containers intact? N/ YES NO 4. Are custody seals on sample containers intact? N/A ' YES NO 5. Is there a COC (Chain-of-Custody) present or other representative documents? Y NO a. Is the COC (if applicable) complete and legible? N/A ~ NO ~, Are bottle IDs legible and in agreement with COC sample IDs? N/A ® NO g, Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A ~ NO 9. Were airbills present and/or removable? N YES NO 10. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A YES NO it. Are all aqueous non-preserved samples at the correct pH? N/A YES NO lz. Is there sufficient sample for the requested analyses? Y NO is. Were all samples placed in the proper containers for the requested analyses? YES NO 14. Are all samples within holding times for the requested analyses? YES NO ts. Were all sample containers received intact? (not broken or leaking, etc.) YES NO t6. Are ali samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon), headspace free? Size of bubble: _ < green pea _> green pea N/A YES NO l~ Were samples checked for and free from the presence of residual chlorine? (Applicable when PM has indicated samples are from a chlorinated water soume; note if field preservation with sodium Ihiosulfate was not observed.) N/A YES NO ls. Were the sample(s) shipped on ice? N/A YES NO t9. Were cooler temperatures measured at 0.1-6.0°C? IR gun used*: #1 #2 N/A YES NO *IR Gun #L Raytek, SN SC-PM3/r29403 COOIeI #~S qq 'IR Gun #2: Oakton, SN 2SCIR1201 Temperature ~rtw~biP~ No. of custody seals N ~ DOT s°rveri External µR/ltr reading Nf} Acceptance inrennauon Background µR/hr reading Were eztemal µR/hr readings <_ two times background and within DOT acceptance criteria? ~ NO (If no, see Fotm 008.) AddltloIIal IIIIOCMatlOn: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE EXCEPT #1 AND #2. • (`~.Ile~i, C~~.~r ra-. ~.t`1C, is l~sae~( ~s (a~.2`f h~ tlr~~ is yfes SK..~cJ. I _ -~ ~ ~ ' SLcw L,P ~e S rE.CRa V-e-.~ r~- ~.,-.-~ ~ i r'.~~ -tc-c+--/J2r~ ~~ WerL /Lo'~"' n ~A ~ +-CP rs2 i2~-f (J f`I tS G.IS S L ~t If applicable, was the client contacted? YES / NO / ~ Colntact Name: Date/Time: Project Manager Signature/ Date: ~ 7l~ I °`"~ Form 201 r18.xls (6126/04) Page 1 of