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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: [' E M ~,x Workorder No: O S I ZO I O <br />Project Manager: <br />Initials: SL. Date: 12• I • OS <br />1. Does this project require any special handling in addition to standard Paragon 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? /A YES NO <br />5, 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 YES NO <br />q, 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 />12, Is there sufficient sample for the requested analyses? YE NO <br />13, Were all samples placed in the proper containers for the requested analyses? 'E NO <br />la. Are all samples within holding times for the requested analyses? E5 NO <br />15. 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 />thiosulfate was not observed.) <br />N/A <br />YES <br />NO <br />la. Were the sample(s) shipped on ice? N/A YES NO <br />lq. Were cooler temperatures measured at 0.1-6.0°C? ~ N/A YES NO <br />*IR u used circle one : 2 - Oakton InfraPro II, SN2922500201-0066; #4 - Oakton InfraPro R, SN2372220101-0002 <br />Cooler #'s ~ <br />Temperature (°C) Z. <br />No. of custody seals <br />DOT <br />sarv°yi External µR/11r reading ^~_ <br />Acceplanca <br />imw°,auo° Background µR/hr reading ~~ <br />Were external µRlhr readings <_ [wo times background and within DOT acceptance criteria? .S / lV0 (If no, see Fonn 008 J <br />Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE EXCEPT #1 AND #2. <br /> <br /> ~ <br />~ Sa T~~3 ~o~r me}als aiv5'S ~o ~e ~i ~-~eve ~ IDveSt..vP <br />rti (Z~. <br /> <br />If applicable, was the client contacted? YES / NO <br />Project Manager Signature/ Date: ~ L 2 <br />Form 201 r18.xls (6/26104) <br />Date/Time: <br />Page 1 of ~ <br />