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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: [~ E M £.X Workorder No: 5 0 9 1 ~ <br />Project Manager: _J M ~ Initials: ~ L Date: q , (7 . Q 5 <br />1. 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? N/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 />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 />9, Were airbills present and/or removable? N/A NO <br />10. Ar'e all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) / YES NO <br />I1. Are all aqueous non-preserved samples at the correct pH? N/A YES 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? ~ NO <br />Ia. Are all samples within holding times for the requested analyses? ES NO <br />15. Were all sample containers received intact? (not broken or leaking, etc.) YES NO <br />I6. 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 />lg. 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 />*IR un used (circle one : 2 - Oakton InfraPro B, SN2922500201-0066; #4 - Oakton.InfraPro II, SN2372220101-0002 <br />Cooler #'s <br />Temperature (°C) 2 •$ <br />No. of custod seals ~ <br />oor <br />s°rvey/ External µR/lu reading I b <br />Acceptance <br />mrarmauon Background µR/hr reading ~_ <br />Were extemai µR/hr readings <_ two times background and within DOT acceptance criteria? $ / NO (If no, see Form 008.) <br />aumaonaramurmauon: PRUVIDEDla'AILS BBLOW FORANO RESPONSE TO ANY QUESTION ABOVE EXCEPT#1 AND#2. <br />* r. awcti~ec I-rr~ty r~ 1~- oln <br />_ <br />_ n1- Iz <br />~ <br />~' Sav`^1 ~03 t'~V- Y~1P}al< ~~~I ~S ~n ~e ~' ~-~Cv ect aNd <br />ve5[u~PC, ~ ti (R6 <br /> ~ <br />~r°+e -. Cea yy~s ~h ca~le~- W'~Inov-I- ~Ha ~AQQ T ~S Sc4alkec~, <br />If applicable, was the client contacted? YES / NO <br />Contact <br />Date/Time: <br />Project Manager Signature/ Date: <br />Form 201r18.xls (6/26/04) <br />~// <br />Page 1 of ~ <br />