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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: [' E~,.t F,~C Workorder No: O J' i O Z fp (p <br />Project Manager: ,J (yl ~ Initials: Sc-- Date: 1 Q' L7• ps <br />1, Does this project require any special handling in addition to standazd Paragon procedures? YES <br />2, Is pre-screening required per SOP 008? YES <br />3, Are custody seals on shipping containers intact? / YES NO <br />a, Are custody seals on sample containers intact? /A YES NO <br />s, Is there a COC (Chain-of-Custody) present or other representative documents? YES NO <br />6. Is the COC (if applicable) complete and legible? N/A YES NO <br />z Are bottle IDs legible and in agreement with COC sample IDs? N/A YES NO <br />g. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A YES NO <br />q. Were airbills present and/or removable? N/A NO <br />10, Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) / YES NO <br />1 t. Are all aqueous non-preserved samples at the correct pH? N/A YE NO <br />Iz. Is there sufficient sample for the requested analyses? YE NO <br />t3. Were all samples placed in the proper containers for the requested analyses? ~ NO <br />la. Are all samples within holding times for the requested analyses? ES NO <br />Is. Were all sample containers received intact? (not broken or leaking, etc.) YES NO <br />16. Are all samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon), <br />headspace free? Size of bubble: _ < green pea _> green pea N/A YES NO <br />17 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 <br />thiosulfate was not observed.) <br />N/A <br />YES <br />NO <br />Ig, Were the sample(s) shipped on ice? N/A YES NO <br />19. Were cooler temperatures measured at 0.1-6.0°C? - N/A YES NO <br />*IR n used circle one) : #2 - Oakton InfraPro II, SN2922500201-0066; #4 - Oakton InfraPro II, SN23722201 OI-0002 <br />Cooler #'s ~ <br />Temperature (°C) 4• Z <br />No. of custody seals ~~ <br />DOT <br />sarvey/ External µR/hr reading NA' <br />Acceptance <br />w°m,as~ Background µR/ltr reading ~_ - <br />Were external µR/Iv readings 5 two times background and within DOT acceptance criteria? S / NO (If no, see Farm 008,) <br />If applicable, was the client contacted? YES / NO /~ Contact Name: <br />Project Manager Signature/ Date: <br />Form 20tr'I S.xls (6126104) <br />Datelfime: <br />Page 1 of ~ <br />Additional InfOrmatiOn: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUES'I'R71Q7~OVE EXCEPT #1 AND #2. <br />