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Paragon Ana/yflcs <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: CEME.~ WorkorderNo: h5n5rSiZ <br />Project Manager: ,J /ttl ~ Initials: ~~ Date: 5.3.05 <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 shippittg containers intact? / YES NO <br />4. Are custody seals on sample containers intact? /A YES NO <br />S, Is there a COC (Chain-of-Custody) present or other representative documents? YES NO <br />6_ Is the COC (if applicable) complete and legible? N/A YES NO <br />z 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 YE NO <br />9. Were airbills present and/or removable? N/A NO <br />10. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) / YES NO <br />11. Are all aqueous non-preserved samples at the correct pH? N/A YE NO <br />t2. Is there sufficient sample for the requested analyses? YE NO <br />13. 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? S NO <br />ls. Were all sample containers received intact? (not broken or leaking, etc.) YES 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/A 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 />thiosulfa[e was no[ observed.) <br />N/A <br />YES <br />NO <br />lg, Were the sample(s) shipped on ice? N/A YES NO <br />19. Were cooler temperatures measured at 0.1-6.0°C? - N/A YES ~ NO <br />*IR u used circle one 2 - Oakton InfraPro lI, SN2922S00201-0066; #4 - Oakton InfraPro II, SN 2372220101-0002 <br />Cooler #'s I <br />Temperature (°C) 3 •4 <br />No. of custody seals $ <br />ooT <br />sarveyi External µR/lir reading 1 ~ <br />Acceptance <br />mro~auo¢ Background p.R/hr reading I?~ <br />Were external µR/tu readings <_ two times background and withi¢ DOT acceptance criteria? YES Nl) (If no, see Form 008.) <br />Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTIO~V'7CBOVE EXCEPT Nl AND #2. <br />C ~l <br />~ sees rrr;Cllyd a ~V LO~' 12. <br />~ <br />' <br />olr me}al< v~atl~s <br />** Sa~ole~ {- ~ ~r ~i ~~evecL aN~ ro~eseY~ ~ti 1z6. <br /> <br />If applicable, was [he client contacted? YES / NO <br />Project Manager Signature/ Date: _G~- ~~ ~~J <br />Form 201 r18.x15 (6/26/04) <br />DatelTime: <br />Page 1 of ~ <br />