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/~ CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Ana/yfics <br />Client: CE M E ,~ Workorder No: 0 (o O 1125 <br />Project Manager: J ML-, Initials: ~ t_ Date: 1-20 • ofo <br />1. Does this project require any special handling in addition to standard Pazagon procedures? ~ YES NO <br />2. Are custody seals on shipping containers intact? NONE YES ~., <br />3. Are Custody seals on sample containers intact? ,~FION li YES NO <br />a. Is there a COC (Chain-of-Custody) present or other representative doclunents? NO <br />s. Are the COC and bottle labels complete and legible? YE NO <br />e. Is the COC in agreement with samples received? (IDs, dates, times, no. of samples, no. <br /> <br />of containers, matrix, requested analyses, etc.) yES NO <br />? Were airbills /shipping documents present and/or removable? Do °P YE NO <br />s. Are all aqueous samples requiring preservation preserved correctly? (excluding volatiles) N/A YES O <br />9. Are all aqueous non-preserved samples pH 4-9? N/A YES NO <br />lu. Is there sufficient sample for the requested analyses? YES NO <br />tL Were all samples placed in the proper contaiuers for the requested analyses? YE NO <br />]z. Are all samples within holding times for the requested analyses? YES NO <br />13. Were all sample containers received intact? (not broken or leaking, etc.) YES NO <br />ta. Are all samples requiring no headspace (VOC, GRO, Rx CN/S, radon), headspace free? <br /> <br />Size of bubble: _ < green pea _> green pea N/A YES NO <br />]s. Were samples checked for and free from the presence of residual chlorine? <br />(Applicable when PM has indicated samples are from a chlorinated water source; note if field preservation with sodium N/A YES NO <br />thiosulfate was not observed. <br />]e. Were the samples shipped on ice? S NO <br />]z Were cooler temperatlues measured at 0.1-6.0°C? IR gun used*: #2 #4 ON~Ly YE NO <br />Cooler #: <br />Temperature (°C): 3 • S <br />No. of custod seals on cooler: <br />DOT <br />son-ayr External µR/ltr reading: <br />Acceptance <br />imom,anon Background µR/lir reading: ~_ <br />Were extema] µR/hr readings 5 two times background and within DOT acceptance criteria? YES / O / NA (If ao, see Form 008.) <br />Additional Inf07IDatiDn: PROVIDE DETAII,S BELOW FOR ANO RE5PONSE TO ANY QUESTION ABOVE,EXCEPT #]AND#16. <br />q.04 <br />If applicable, was the client contacted? YES / N / NA ontack Date/Time: <br />Project Manager Signature /Date: <br />`IR Gun #2: Oakton, SN 29922500201-0066 •IR Gun #4: Oakton, N 237222 101-0002 <br />Forth 20tr19.xls (1/13!06) <br />Page 1 of ~ <br />