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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Analytics <br />Client: ~ t' /l1c ~ Workorder No: O 't ®~ 2~ g <br />Project Manager: ~ Initials: ,~-~ Date: ~ 2 ~ o~ <br />t. Does this project require any special handling in addition to standard Pazagon procedures? YES N <br />z. Is pre-screening required per SOP 008? YES I30 <br />3. Are custody seals on shipping containers intact? A YES NO <br />4. Are custody seals on sample containers intact? !A YES NO <br />s. Is there a COC (Chain-of-Custody) present or other representative doctmients? ES ~ NO <br />e. Is the COC (if applicable) complete and legible? N/A YES NO <br />T. Are bottle IDs legible and in agreement with COC sample IDs? N/A YE NO <br />s. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A NO <br />9. Were airbills present and/or removable? N1A YES NO <br />[o. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A YES NO <br />[[. Are all aqueous non-preserved samples at the correct pH? N/A YES NO <br />tz. Is there sufficient sample for the requested analyses? S NO <br />13. Were all samples placed in the proper containers for the requested analyses? YES NO <br />(4. Are all samples within holding times for the requested analyses? YES NO <br />ts. Were all sample containers received intact? (not broken or leaking, etc.) YES NO <br />Are all samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon), <br />16. <br />headspace free? Size of bubble: _ < green pea > green pea yES NO <br />Were samples checked for and free from the presence of residual chlorine? (Applipab[e <br />[~~ when PM has indicated samples are from a chlorinated water source; note if field preservation with sodium thiosulfa[e wa <br />- N/ <br />YES <br />NO <br />ta. Were the sample(s) shipped on ice? YES NO <br />t9. Were cooler tem eratures measured at 0.1-6.0°C? IR gun used*: #1 #2 N/A YES NO <br />•IR Gm #1: Raytek, SN SC-PM3/I'29403 Cooler #: <br />•[a Gan #z: oaktca. sx zsc[R[zot Temperature (°C): 13v 2 "~- <br />No. of custod seals on cooler: <br />DOT <br />s°n,eyi External µR/hr reading: <br />Acceptance <br />intormati°n Background µR/hr reading: ' <br />Were external µR/hr readings < two times background and within DOT acceptance criteria? YES / NO (If no, see Form 008.) <br />If applicable, was the client contacted? YES / O NA Contact Name~:1 Date/Time: <br />Project Manager Signature/ Date• ~~'~ g 3 (/ <br />Form 207r18.xls (6/26/04) <br />Page 1 of <br />~~ <br />Additional Information: PROVIDE DErAIL.S BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE EXCEPT #I AND #2. <br />