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Paragon Analytics CONDITION OF SAMPLE UPON RECEIPT FORM Client: ('_ Ef,,~~,~ Workorder No: ~ 5 O $ I $y Project Manager: ,J /ld ~ Initials: St- Date: $• 19.05 1. Does this project require any special handling in addition to standard Paragon procedures? YES 2, Is pre-screening required per SOP 008? YES 3, Are custody seals on shipping containers intact? ' / YES NO q, Are custody seals on sample containers intact? /A YES NO s, Is there a COC (Chain-of-Custody) present or other representative documents? YES NO 6, Is the COC (if applicable) complete and legible? N/A YES NO 7, Are bottle IDs legible and in agreement with COC sample IDs? N/A YES NO g. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A YES NO q. Were airbills present and/or removable? N/A NO lo. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) / YES NO i 1. Are all aqueous non-preserved samples at the correct pH? N/A YE NO 12. Is there sufficient sample for the requested analyses? YE NO 13. Were all samples placed in the proper containers for the requested analyses? ~ NO la. Are all samples within holding times for the requested analyses? ~ S NO 15. Were all sample containers received intact? (not broken or leaking, etc.) YES NO 16. Are all samples requiring no headspace (volatiles, reactive cyarude/sulfide, radon), headspace free? Size of bubble: _ < green pea _> green pea N/A YES NO 17 Were samples checked for and free from the presence of residual chlorine? (Applicable when PM has indicated samples an: from a cLlocina[ed water source; note if field preservation with sodium thiosulfate was not observed.) N/A YES NO lg, Were the sample(s) shipped on ice? ~~ N/A YES NO 19. Were cooler temperatures measured at 0.1-6.0°C? N/A YES NO •IR u used (circle one) : 2 - Oakton InfraPtn II, SN2922500201-0066; #4 - Oakton InfraPro II, SN2372220101-0002 Cooler #'s ~ Temperature (°C) y • 2 No. of custody seals oor sareyi External µR/lu reading 13 Acceptance mmrtnauoa Background µR/hr reading 13 ~ - Were external µR/Iv~ readings 5 two times background and within DOT acceptance criteria YES NO (If no, see Form 008.) If applicable, was the client contacted? YES / NO / (ivrl /Contact Name: Date/Time: Project D4anager Signature/ Date: ~/ y2 Form 2D'1r18.xls (6/26/04) Page 1 of ~ .,....,..v..... ....v. ,..o....u. rnv v~Ln a.nrevia nnr.v rr rvrcn rvv tccarVrvan 1V AIVY(jUr:J'1'1()N Ak3UVE. h:X(:EPT ill .rWD#2.