Laserfiche WebLink
Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: (~ E M ~.X Workorder No: _ ~ S ~~ 1 ~ 3 <br />Project Manager: ,, M ~ Initials: ~ Date: JJ N <br />1, Does this project require any special handling in addition to standard Paragon procedures? YES <br />z. 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? N/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 />7, 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 YE 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 />lz. Is there sufficient sample for the requested analyses? YE NO <br />l3. Were all samples placed in the proper containers for the requested analyses? ~ NO <br />l4, Are all samples within holding times for the requested analyses? S NO <br />15. ~T/ere all sample containers received intact? (not broken or leaking, etc.) YES NO <br />l6. 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 />l7 V/ere samples checked for and free from the presence of residual chlorine? <br />(Applicable when PM bas indicated samples are from a chlorinated water source; note if 5eld preservation with sodium <br />tfiiosulfate was not observed.) <br />N/A <br />YE$ <br />NO <br />1s. 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 />*I,R un used (circle one : 2 - Oakton 1nfraPro R, SN2922500201-D066; #4 - Oakton InfraPro II, SN2372220101-0002 <br />Cooler #'s 1 <br />Temperature (°C) Q. (p <br />No. of custody seals ~' <br />DDT <br />s~rveyr External µR/hr reading `~ <br />Acceptance <br />1°t°°°aaO° ~ BackgmundµR/hrteatiing ('j <br />Were external µR/Iv readings <_ two times background and within DOT acceptonce criteria? S NO (lf no, see Ponn ODS_) <br />Add1t10na1lnformattnn: PROVIDE DETAILS BELOWFORANORESPONSETOANYQUES OVEEXCEPTHIAND#2. <br />~` r c ; ~I- a ~- ~P c xr c ~ t ~tr~_3 ~ _~l~Q ~ 12. <br />*-saw ~~ ~r-me}~.L-a~s -k~ ~e £~ f-~e~ ec~ a~.:l rav <br />esev~rd~ ~ lab <br /> ~. <br />If applicable, was the client contacted? YES / NO / NA Contact <br />Project Manager Signature/Date: ~_~%~j <br />1' <br />Fnrm 201r16.xls (6126104) <br />DatefTime: <br />Page 1 of ~ <br />