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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: ~~~(~~ Workorder No: (\ "j 0 a{ LS 7 <br />Project Manager: .~ (w~ Initials: ~L Date: 4-L3 • oS <br />1. Does this project require any special handling in addition to standard Paragon procedures? YES NO <br />2. 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/ YES NO <br />5, 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 NO <br />7. Are bottle IDs legible and in agreement with COC sample IDs? N/A NO <br />g. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A NO <br />q. Were airbills present and/or removable? /A YES NO <br />10, Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A NO <br />a 1. Are all aqueous non-preserved samples at the correct p$? N/A NO <br />i2, Is there sufficient sample for the requested analyses? C~ NO <br />t3. Were all samples placed in the proper containers for the requested analyses? NO <br />Ia. Are all samples within holding times for the requested analyses? YE NO <br />Is. Were all sample containers received intact? (not broken or leaking, etc.) YE NU <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/ <br />YES <br />NO <br />ta. Were the sample(s) shipped on ice? N/A YES <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, SN2372220101-0002 <br />Cooler #'s <br />gt.4.11' T <br />Temperature (°C~~'~ <br />No. of custody seals h~ f} <br />s~Nayi External µR/hr reading ~~ <br />Acceptance <br />Nformation Background µR/hr reading _(~ <br />Were external µR/hr readings < two times background and within DOT acceptance criteria? .S NO (If no, see Form 008.) <br />)f' <br />If applicable, was the client contacted? YES / NO /~fjCfontact Na~m/e: ~ ~!' Date/Time: <br />Project Manager Signature/ Date: ~==-~~~1/ ~/_ / /jl~~ <br />Form 201r78.xls (s/zs/oa) Page 1 of+ <br />Addifional Informakion: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE BXCEPT #1 AND #2. <br />