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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: ~~P~.< Workorder No: Q ~~ (Z C7S <br />qq~^ <br />ProjectManager: ~T~ Initials: (~' Date: /~'~ <br />t. Does this project require any special handling in addition to standard Paragon procedures? YES N <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? / YES NO <br />s. Is there a COC (Chain-of-Custody) present or other representative documents? YES O <br />6, Is the COC (if applicable) complete and legible? N/A YES N <br />7, Are bottle IDs legible and in agreement with COC sample IDs? N/A YES <br />g, Is the COC in agreement with samples received? (# of samples, # Of containers, matrix) N/A YE O <br />q. Were airbills present and/or removable? N/A NO <br />t0. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A YES NO <br />1t. Are all aqueous non-preserved samples at the correct pH? N/A S NO <br />tz. Is there sufficient sample for the requested analyses? YE NO <br />I3, Were all samples placed in the proper containers for the requested analyses? NO <br />14, Are all samples within holding times for the requested analyses? NO <br />15. Were all sample containers received intact? (not broken or leaking, etc.) NO <br />t6. Are all samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon), <br />headspace free? Size of bubble: < green pea _> green pea /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 />tktiosulfate was not observed.) <br />N/ <br />YES <br />NO <br />Is, Were the sample(s) shipped on ice? N/A NO <br />19. Were cooler temperature asured at 0.1-6.0°C? N/A NO <br />"IR uu used (circle one : 2 - Oakton InfraPro B, SN2922500201-0066; #4 - Oakton InfraPro R, SN2372220101-0002 <br />Cooler #'s ~ <br />Temperature (°C) U, ! oC <br />No. of custod seals _~ <br />s~rvayt External µR/hr reading ~Z <br />Acceptance <br />mt°aaae~°° Background µR/hr reading <br />Were external µR/hr readings 5 two times background and within DOT acceptance criteria? YES / NO (If no, see Form 008.) <br />If applicable, was the client <br />NA Contact N <br />Date/T' <br />/~ <br />Project Manager Signature/Date: =/--~~~ l2/ ~~~ <br />C` <br />Form 201r18.xls (6/26/04) <br />Page 1 of <br />Additional Information: PR~/O'VIDE DETAILS BELOW FOR A NO RESP/O~NS/E TO ANY QUESTION ABOVE EXCEPT #I AND #2. <br />SCu TO/~ ~a' ~~ ~' !T ~C ~Z ~ WC Gat ~d '~i ~~rr 4ad~/Jr il+t v:. ~/ <br />