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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Anaiytics <br />O (O ~ ~f X07 <br />Client: ~e.Gt^2-3~- WorkorderNo: ,~.(~r.~~B s-/~~p/~f <br />Projectlvlanager: ~.~ Initials: ,~~-((~_ Date: t-( ( pC,- <br />t Does this project require any special handling in addition to standazd Pazagon procedures? YES <br />2. Are custody seals on shipping containers intact? NONE ~ NO <br />s. Are Custody seals on sample containers intact? NONE ~ NO <br />a. Is there a COC (Chain-of-Custody) present or other representative documents? NO <br />% Are the COC and bottle labels complete and legible? NO <br />a. Is the COC in agreemenfwith samples received? (IDs, dates, tithes, no. of samples, no. ~ NO <br />of containers, matrix, requested analyses, etc.) <br />? Were airbills /shipping documents present and/or removable? DROP oFr ® NO <br />s. Are all aqueous samples requiring preservation preserved correctly? (excluding volatiles) YES O <br />s. Are all aqueous non-preserved samples pH 4-9? N/A4 t YES <br />to. Is there sufficient sample for the requested analyses? ~ NO <br />11. Were all samples placed in the proper containers for the requested analyses? NO <br />~z. Are all samples within holding times for the requested analyses? NO <br />tt. Were all sample containers received intact? {not broken or leaking, etc.) NO <br />1a. Are all samples requiring no headspace (VOC, GRO, Rx CN/S, radon), headspace free? ~ YES NO <br />Size of bubble: _ < green pea ,> green pea <br />u. 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 ~ YES NO <br />thiosulfate was not observed. <br />tc. Were the samples shipped on ice? ~ NO <br />xAn <br />L7 Were cooler temperatures measured at 0.1-6.0°C? ut gnn uaea*: #2 oNLV <br />YES <br />O <br />Cooler #: <br />Temperature (°C): `a, $ <br />No. of.custody seats on cooler: <br />oor <br />seen External µItlhr reading: <br />Acceptance - <br />InfeTlatinn Baclcgrotmd }tR/hr reading: I ~- - ~ . <br />Were external µR/lu readings < two fimes background and within DOT acceptance~cri[eria? / NO / NA Qf no, see Form 008.) <br />Additional Information: PROVIDE DETAILS BELOW FOR ANO RESPONSE TO ANY QUESTION ABOVE, EXCEPT #1 AND #16. <br />I_ //O/'O ~„/ Gtw G/~ li n O/~<C.~/Y f nns. ir.~, a \ <br />/. <br />~. <br />2• <br />veee~t/.Clt Rloowe fia~+.n• -I~t- re~.cff/R Rna(yStS. <br /> <br />If applicable, was [he client contacte .YES / O / NA Contact: ~~ G DatelTime: <br />Project Manager Signature /Date: ~ ~~ 3 ~O <br />'IR Gun #2: Oakton, SN 29922500201-0066. "IR Gun #4: Oakton, SN 2372220101-0002 <br />Form 201r19.xls (1/13/06) <br />Page ~ of <br />