HYDRO27557

• Permit No: M1977208
• IBM Index Class Name: Hydrology
• Doc Date: 8/3/2005
• Doc Name: water sample results and level
• From: cemex
• To: dmg
• Media Type: D
• Archive: No

Paragon Analytics
CONDITION OF SAMPLE UPON RECEIPT FORM
Client: ClrME.~ WorkorderNo: n50700°j
Project Manager: ,J M l; Initials: S L Date: 7. 16 S
t. Does this project require any special handling in addition to standard Paragon procedures? YES
2, Is pre-screening required per SOP 008? YES
3, Are custody seals on shipping containers intact? / YES NO
4. Are custody seals on sample containers intact? /A YES NO
s, Is there a COC (Chain-of-Custody) present or other representative documents? YES NO
6, Is the COC (if applicable) complete and legible? NIA YES NO
7, Are bottle IDs legible and in agreement with COC sample IDs? N/A YES NO
g. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A YES NO
y, Were airbills present and/or removable? N/A YE NO
10. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) / YES NO
II. Are all aqueous non-preserved samples at the correct pH? N/A YE NO
iz. Is there sufficient sample for the requested analyses? YE NO
13. Were all samples placed in the proper containers for the requested analyses? ~ NO
la. Are all samples within holding times for the requested analyses? S NO
15. Were all sample containers received intact? (not broken or leaking, etc.) YES NO
16. Are all samples requiring no headspace (vola$les, reactive cyanide/sulfide, radon),
headspace free? Size of bubble: _ < green pea _> green pea N/A YES NO
17 Were samples checked for and free from the presence of residual chlorine?
(Applicable when PM has indicated samples are from a chlorinated water source; note if Feld preservation with sodium
thiosulfate was not observed.)
1`I/A
YE$
N~
ig. Were the sample(s) shipped on ice? N/A YES NO
i9, Were cooler temperatures measured at 0.1-6.0°C? N/A
*IR un used (circle one 2 - Oakton InfraPro II, SN2922600201-0066; #4 - Oakton InfraPro II, SN2372220101-0002
Cooler #'s /
Temperature (°C) 7. (o
No. of custody seals
s~NeYl External pR/hr reading
Acceptance
mrormauan Background µR/tu reading
Were external µR/hr readings S two times backgr°und and within DOT acceptance cri[eri YE / NO (If no, see Form 008.)
Anntnonal lnlOrmanOn: PROVIDE DETAILS BELOW FOA A NO RESPONSE TO ANY QUESTION ABOVE EXCEPT tkl AND tt2.
K
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9
If applicable, was the client contacted? PE NO / NA Contact Name: ~z,., ~~~ Date/Time:
Project Manager Signature/ Date:
Form 201r18.xls (6126104)
Page 1 of ~
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