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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Analyfics <br />Client: ~ EAA E)(, Workorder No: 0 (a (~ N LO 9 <br />Project Manager: ~1Pet~ f~v/rt Initials: S~ Date: y-dS-O(o <br />1. Does this project require any special handling in addition to standazd Pazagon procedures? YES NO <br />2. Are custody seals on shipping containers intact? ONE YES NO <br />3" Are Custody seals on sample containers intact? O YES NO <br />a. Is there a COC (Chain-of-Custody) present or other representative documents? YES NO <br />s. Are the COC and bottle labels complete and legible? YES NO <br />e. Is the COC in agreement with samples received? (IDs, dates, fv-nes, no. of samples, no. <br />of containers, matrix, requested analyses, etc.) yES NO <br />~ Were airbills /shipping documents present and/or removable? DROP OFF YES NO <br />8. Are all aqueous samples requiring preservation preserved correctly? (excluding vola6les) N/A YES 0 <br />9. Are all aqueous non-preserved samples pH 4-9? N/A ES NO <br />to Ts there sufficient sample for the requested analyses? YES NO <br />u.-Were all samples placed in the proper containers for the requested analyses? ~ NO <br />lz. Are all samples within holding times for the requested analyses? ® NO <br />13. Were all sample containers received intact? (not broken or leaking, etc.) YES NO <br />ta. Are all samples requiring no headspace (VOC, GRO, Rx CN/S, radon), headspace free? <br />Size of bubble: _ < green pea" _> green pea N/A YES NO <br />ls. Were samples checked for and free from the presence of residulal chlorine? <br />(Applicable when PM has indicated samples aze from a chlorinated wafer source; note if field preservation with sodium <br />tlriosulfate was no[ observed. <br />N/A <br />YES <br />NO <br />Is. Were the samples shipped on ice? YE NO <br />lz Were cooler temperatures measured at 0.1-6.0°C? iR guuused*; #2 #4 ~ YES NO <br />Cooler #: 1 __ <br />Temperature (°C): 5• (o __ <br />No. of custody seals on cooler: -~- <br /> __ <br />DOT <br />survnvt Extema] µRlhr reading: } Z - " <br />Acceptance ~~ <br />Information Background µR/hr reading: ~ _ " <br />Were external µR/hr readings <_ two times background and within DOT acceptance criteria? S O / NA (If no, see Form 008.) <br />Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE'CO ANY QUESTION ABOVE, EXCEPT #1 AND #16. <br /> <br />.i- <br />If applicable, was the client contacted? YES / N 'N Contact: ~ Date/Time: <br />Project Manager Signature /Date: ~'~~(p <br />*IR Gun #2: OaMon, SN 29922500201-0066. <br />Form 201r19.xls (1/13/06) <br />`IR Gun #a: Oaktou, SN 2372220101-0002 <br />1 of <br />