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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Analytics <br />Client: C G /AIL ZG Workorder No: ~~ (~ ~ L~I~J~' <br />Project Manager: JM G~ Initials: ~ A I Date: -/ e/-d y <br />1. Does this project require any special handling in addition t tandard Paragon procedures? YES N <br />z. Is pre-screening required per SOP 008? YES NO <br />3. Are custody seals on shipping containers intact? N/ YES NO <br />a. Are custody seals on sample containers intact? N/A YES NO <br />s. Is there a COC (Chain-of-Custody) present or other representative documents? YES' NO <br />s. Is the COC (if applicable) complete and legible? N/A YE NO <br />~. Are bottle IDs legible and in agreement with COC sample IDs? N/A E NO <br />s. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A S NO <br />9. Were airbills present and/or removable? N/A E NO <br />]o. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A YES N <br />n. Are all aqueous non-preserved samples at the correct pH? N/A YES o <br />]z. Is there sufficient sample for the requested analyses? ~ NO <br />13. Were all samples placed in the proper containers for the requested analyses? YES NO <br />]a. Are all samples within holding times for the requested analyses? YES NO <br />]s. 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 />]e. headspace free? Size of bubble: _ < green pea > green pea <br />N/ <br />YES <br />NO <br />Were samples chec e or and ree rom the presence o residual chlorine? (Applicable <br />17. when PM has indicated samples are Gom a chlorinated water source; note if field preservation with sodium thiosulfate was <br />not observed. <br />/A <br />YE$ <br />NO <br />18. Were the samples shipped on ice? N/A E NO <br />]e. Were cooler temperatures measured at 0.1-6.0°C? IR gun used*: #1 2 N/A E NO <br />"Il2 Gun Ml: Raytek, SN SC-PM3II29A03 Cooler #: I <br />"m Gua nz: oakt°a, sN zscBClzo] Temperature (°C): ~. (,+ <br />No. of custody seals on cooler: ~_ <br />ooT <br />s°rveyi External µR/ly reading: ' <br />Acceptance <br />mrormar°~ Background µR/hr reading: <br />Were external µR/hr readings <_ two times background and within DOT acceptance criteria? S / O (If no, see Form 008.) <br />Additional lntormafion: PROVIDE\\DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABO~n7VE EXCEPT/1•1 AND N2. <br />° Srn.n~s ~ ~ ~~-P.+1 .~._ dnL~x n,. ...~. n:.s n.s~~ c~_ ~1Ct ~'?, !('-0.~~ <br />If applicable, was the client contacted? YES ~/ NA Contact Name: Date/Tune: <br />Project Manager Signature/ Date: <br />Form 201 r18.xls (6/26/04) Page 1 of L <br />