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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: CP(/Yt ~\ f tit Workorder No: d S ~a ~S <br />Project Manager: ~V' 1 ~ Initials: Date: ~~%S O <br />1. Does this project require any special handling in addition to standard Pazagon procedures? YES <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? YES NO <br />5. Is there a COC (Chain-of-Custody) present or other representative documents? ~E~ 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 />8, Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A ~ NO <br />q, Were airbills present and/or removable? N/A NO <br />10. Ale all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A YES ~ <br />11. Are all aqueous non-preserved samples at the correct pH? N/A Y~ NO <br />12. Is there sufficient sample for the requested analyses? ~S' 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? NO <br />I5. Were all sample containers received intact? (not broken or leaking, etc.) ES 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/ 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 />[hiosulfate was not observed) <br />/A <br />YES <br />NO <br />I8, Were the sample(s) shipped on ice? N/A ~I S NO <br />19. Were cooler temperatures measured at 0.1-6.0°C? N/A i5~9 NO <br />*IR un used (circle one : #2 - Oakton InfraPro R, SN2922500201-0066; - Oakton InfraPro II, SN237222010]-0002 <br />Cooler #'s J <br />Temperattue (°C) ~~ <br />No. of custody seals ~ <br />oor <br />s°rreyi External µR/hr reading / <br />Aaeptance <br />Information Background µR/hr reading I Z <br />Were external µR/hr readings < two times background and within DOT acceptance criteria? ~O (If no, see Form 008.) <br />If applicable, was the client contacted? YES / NO / ~ Contact Name: Date/Time: <br />Project Manager Signature/ Date: ~ L 9% <br />Form 201r18.xls (6126104) ( <br />Page 1 of _ <br />Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE EXCEPT #1 AND #2. <br />