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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Analytics <br />Client: ~ ~~~)~ Workorder No: 0 ((~~ ~~ <br />Project Manager: ,~,~ t Initials:. ~jr/ Date: ~-~-~ <br />1. Does this project require any special handling in addition to standard Paragon procedures? YES <br />z. Are custody seals on shipping containers intact? j O NO <br />3. Are Custody seals on sample containers intact? NONE NO <br />a. Is there a COC (Chain-of-Custody) present or other representative documents? 5 NO <br />s. Are the COC and bottle labels complete and legible? Y NO <br />e. Is the COC in agreement with samples received? (IDs, dates, times, no. of samples, no. <br />of containers, matrix, requested analyses, etc.) ES NO <br />7 Were airbills /shipping documents present and/or removable? DROP OFF ES NO <br />a. Are all aqueous samples requiring preservation preserved correctly? (excluding vo]atIles) N/A YES 0 <br />9. Are all aqueous non-preserved samples pH 49? N/A YES <br />1D Is there sufficient sample for the requested analyses? S NO <br />n. Were all samples placed in the proper containers for the requested analyses? YE NO <br />1s. Are all samples within holding times for the requested analyses? S NO <br />1s. Were all sample containers received intact? (not broken or leaking, etc.) S NO <br />]a. Are all samples requiring no headspace (VOC, GRO, Rx CN/S, radon), headspace free? <br />Size of bubble: _ < green pea ,> green pea /A YES NO <br />]s. 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 />1e. Were the samples shipped on ice? YES NO <br />17 Were cooler temperatures measured at 0.1-6.0°C? nt gun used": #2 #4 oNLV YES <br />Cooler #: ~_ <br />Temperature (°C): t7 0 <br />No. of custody seals on cooler: ~_ <br /> DOT /~ <br />sarvey/ External pR/ltr reading: 1= <br />Acceptance <br />Information Background µR/hr reading: <br />Were external µR/hr readings < two times background and within DOT acceptance criteria? 5 0 / NA (If no, see Fotm 006.) <br />Additional Information, PROVIDE DETAILS BELOW FORANO RESPONSE TO ANY QUESTION ABOVE,EXCEPT #1 AND #16. <br />/7faoB~ <br />If applicable, was the client contacted? YES / NO / NA Contact: Date/Time: <br />Project Manager Signature/Date: ~ G7 l~ <br />°IR Gun #2: Oakton, SN 29922500201-0066. *IR Gun #4: Oak[on, SN 2372220101-0002 <br />Form 201 r19.xls (1/13/06) <br />Page 7 of <br />