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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: ~e~[.~~ WorkorderNo: ~~~()~ (~~'~ ~Q <br />Project Manager: ~T(_ Initials: ~~(i ~ Date: ~'- TYJS~ <br />1. Does this project require any special handling in addition to standard Pazagon procedures? YES O <br />2. Is pre-screening required per SOP 008? YES <br />3. Are custody seals on shipping containers intact? / YES NO <br />4_ Are custody seals on sample containers intact? N YES NO <br />5. Is there a COC (Chain-of-Custody) present or other representative documents? ES 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 YES NO <br />g. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A ES NO <br />9, Were airbills present and/or removable? N/A S NO <br />10. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A YES O ~ <br />t t. Are all aqueous non-preserved samples at the correct pH? N/A YES N <br />I.Z. Is there sufficient sample for the requested analyses? Y NO <br />13, Were all samples placed in the proper containers for the requested analyses? NO <br />14, Are all samples within holding times for the requested analyses? E NO <br />ts. Were ali sample containers received intact? (not broken or leaking, etc.) NO <br />15. Are all samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon), <br />headspace free? Size of bubble: _ < green pea _> green pea N/ 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 soune; note if field preservation with sodi <br />[hiosulfate was not observed J <br />N/ <br />YES <br />NO <br />18, Were the sample(s) shipped on ice? N/A YES NO <br />19. Were cooler tempera es ured at 0.1-6.0°C? N/A YES NO <br />'IR uu used (circle one #2 - O ton InfraPro II, S <br />N2922500201-0066; i!4 - Oakton InfraPro II, SN2372220101-0002 <br />r <br />Cooler #'s t <br />Temperature (°C) ~ f) <br />No. of custod seals <br />oor )u <br />s°nerr External µR/lu reading <br />A¢eptanpa <br />i°ro~mauoo BackgroundµR/hrreading (~ ` <br />Were extema! µR/hr readings 5 two times background and within DOT acceptance trite a? YES / N (If no, see Form 008.) <br />Addifional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY Q STION AB EXCEPT #l AND #2. <br />n ~-~ d-~c~= / a~~ ~ l ~'l, b ~ <br />If applicable, was the client contacted~YE NO / NA Contact Name: ~,~~~.I~ Date/Time: 1 ? °~ <br />I~~ o0 <br />Project Manager Signature/ Date: ~- ~ tj YJ/~ <br />Form 201r18.xls (6/26/04) <br />Page 1 of <br />