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Paragon Analytfcs <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: WorkorderNo: ~,!iv Sb7z ~6 <br />I <br />ProjectiManager: JME Initials: Date:~~g/o~ <br />1. Does this pioject require any special handling in addition to standazd Paragon procedures? '~~ I YES ~ <br />2. Is pre-screening required per SOP 008? <br />I YES <br />3. Are custody seals on shipping containers intact? <br />j N YES I NO <br />4, Are custody seals on sample containers intact? '~ N~7zp' YES NO <br />5. Is there a COC (Chain-of-Custody) present or other representative documents? ~ ~ NO <br />6. Is the CO,C (if applicable) complete and legible? N/A ~ ~ ~ NO <br />7, Are bottle IDs legible and in agreement with COC sample IDs? N/A ®E NO <br />g. Is the COG in agreement with samples received? (# of samples, # of containers, matrix) N/A ~ NO <br />q, Were airliills present and/or removable? ~ N/A ~ NO <br />10. Are all agtieous samples requiting preservation preserved correctly? (excluding volatile organics) N/A YES ©O <br />t 1. Are all aqueous non-preserved samples at the correct pH? N/A YES 0 <br />12, Is there sufficient sample for the requested analyses? (~ NO <br />13. Were all samples placed in the proper containers for the requested analyses? ~ I NO <br />I4, Are all samples within holding times for the requested analyses? I NO <br />Is. Were all sample containers received intact? (not broken or leaking, etc.) ~ NO <br />16. Are all samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon), !,', <br />headspace free? Size of bubble: - < green pea _> a een pea ~ yES NO <br />17 Were samples checked for and free from the presence of residual chlorine? 9~ <br />(Applicable when PM has indicated samples are from a chlorinated water source; note if field prescrva[ibn with sodium <br />thiosulfate eras not observed) ' ~~--l <br />G.ly~ <br />YE$ <br />NO <br />]g. Were theisample(s) shipped on ice? ~ N/A NO <br />19. Were cooler temperatures measured at 0.1-6.0°C? ~ N/A ~ NO <br /> *IR un used circle one : #2 - Oakton InfraPro R, SN2922600201-0066; #4 - Oakton InfraPro~Il, SN2372220)O1-0002 <br /> ~, Cooler #'s ~ <br />Temperature (°C) Q, R <br />No. of custody seals ~ <br />DOT <br />serve i External readin ~ ill <br />r µ~~ g <br />Acceptance <br />Udorma0on ~ Background }tR/lu reading <br />Were external µR/lu'readings <_ two fimes background and within DOT acceptance criteria? .S ~ NO <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />f no, see Form 008.) <br />AUfllpptiOnel lIIIOrma[IO//n~~: PROVID 1E DETAB-S BELOW FORANO RESPONSE TO ANY QUESTION ABOVE EXCEPT#1 AND#2. <br />(t'` SN`"O~PS tar /V4Q-V~IS !/~P`h~Ut~< (P/O~NP~ UblrtlPSP(I/Pr~ r ~.v:(~ Io2 <br />- rzii i v . <br /> <br />N <br />If applicable,liwas the client contacted? YES / NO / <br />Project Manager Signature/ Date: <br />Form 201r18.xls (6126/04) <br />Narne: Date/Time: <br />/ '7 ~ i -ate , <br />Page 1 of <br />