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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: Ce4F`Q,~ WorkorderNo: ~~'O~OIs <br />Project Manager: J ME Initials: /ut/ Date: i ~ l <br />1, Does this project require any special handling in addition to standazd Pazagon procedures? YES <br />2. Is pre-screening required per SOP 008? YES <br />3. Are custody seals on shipping containers intact? 117 YES NO <br />y. Are custody seals on sample containers intact? ~ YES NO <br />5, Is there a COC (Chain-of-Custody) present or other representative documents? ~S' 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 />9, Were airbills present and/or removable? N/A ~$ NO <br />to. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A YES I~ <br />11. Are all aqueous non-preserved samples at the correct pH? N/A YES Q~ <br />Iz. Is there sufficient sample for the requested analyses? ~ NO <br />I3, Were all samples placed in the proper containers for the requested analyses? It~§° NO <br />I4, Are all samples within holding times far the requested analyses? ~ NO <br />Is. Were all sample containers received intact? (not broken or leaking, etc.) NO <br />I6. Are all samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon), <br />headspace free? Size of bubble: _ < green pea _> green pea ~ yES NO <br />17 Were samples checked for and free from the presence of residual chlorine? <br />(Applicable when PM has indicated samples an: from a chlodna[ed water source; note ff field preservation with sodium <br />thiosulfate was not observed.) <br />~ <br />YES <br />NO <br />lg. Were the sample(s) shipped on ice? N/A NO <br />19. Were cooler temperatures measured at 0.1-6.0°C? N/A NO <br />*II2 un used circle one #2 - Oakton InfraPro II, SN2922500201-0066; - Oakton InfraPro II, SN2372220101-0002 <br />Cooler #'s <br />Temperature (°C) ,(o ~ <br />No. of custody seals 0 <br />sanev~ External µR/hr reading ~~ <br />Acceptance <br />Information Background µR/lu reading <br />Were external µR/ly readings < two times background and within DOT acceptance criteria? / NO (If no, see Fonn 008.) <br />Additional Information: PROVIDE DECAILS BELOW FOR A NO RESPONSE TO ANY QUEST ABOVE EXCEPT #I AND #2. <br />If applicable, was the client contacted? YES / NO ~fY Contact <br />~~G ~ lZ C3 <br />Project Manager Signature/ Date: -'" ~ <br />Form 201 r18.xls (6/26/04) <br />Date/Time: <br />Page 1 of 1 <br />_ P/tr~..k -v ry., ~-ti-os ~-tl-Fv 4*~0~ or-~tr• /~resc~r-vim /J~~.L,~ <br />t~-, <br />