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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM - <br />Client: C E M E.~ Workorder No: (} S~ S I t~ y <br />Project Manager: ,,,) /tll ~ Initials: ~L Date: S • 19 ~ 05 <br />i, Does this project require any special handling in addition to standard Paragon procedures? I 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 />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? NJA YES NO <br />7. Are bottle IDs legible and in agreement with COC sample IDs? NIA 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 />io. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) f YES NO <br />l 1. Are all aqueous non-preserved samples at the correct pH? NIA YES NO <br />12, Is there sufficient sample for the requested analyses? YE NO <br />t3. Were all samples placed in the proper containers for the requested analyses? ® NO <br />I4, Are all samples within holding times for the requested analyses? NO <br />Is. Were all sample containers received intact? (not broken or leaking, etc.) YE 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 clilorinated water source; note if field preservation with sodium <br />thiosulfate was not observed.) <br />N/A <br />YES <br />NO <br />Ig. Were the sample(s) shipped on ice? NIA ~ YES NO <br />19. Were cooler temperatures measured at 0.1-6.0°C? ~ N/A YES NO <br />*IR un used circle one : 2 - OaMon InfraPm II, SN2922500201-0066; #4 - Oakton InfraPro II, SN2372220101-0002 <br />Cooler #'s [ <br />Temperature (°C) 3. (p <br />No. of custody seals $ <br />s~reyr External µIZllu reading _(~ <br />Acceptance <br />mrortne6°° Background µR/ly reading [ Z- - <br />Were external µR/lu readings < two times background and within DOT acceptance criteria? S / NO (if no, see Fonn 008.) <br />Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTlbh>'ABOVEFXCEPT #1 .AND #2. <br />~` r ola- sav.,h~es rrr~ru,.rl_- a~ o(rt ~0~ IZ <br />' ' <br />~ <br />~ Sa <br />~ <br />_~1 <br />oir-me}a(5. <br />nle3 ~ <br />5iS io ~e ~ <br />' ~-}~,rec~ v~ t~v se,rvr <br />itA (ab <br />. <br />_ <br />~ <br />~ <br />If applicable, was the client contacted? YES / NO /C~TA~Contact Name:c~ ~, <br />Project Manager Signature/ Date: / l ( ~"/ <br />Form 201 r18.xls (6/26/04) <br />Date/Time: <br />Page 1 of ~ <br />