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CONDITION OF SAMPLE UPON RECEIPT FORM d ~, Paragon Anafyfics <br />Client: ~ Ern ESC, Workorder No: a Cp i*j 3 O 6.~- <br />Project Manager: J M E Initials: ___(~ Date: 3 r o k <br />1~ Does this project require any special handling in addition to standazd Paragon procedures? YES NO <br />z Are custody seals on shipping containers intact? ONE YES NO <br />a. Are Custody seals on sample containers intact? O YES NO <br />< Is there a COC (Chain-of-Custody) present or other representative documents? YES NO <br />s. Are the COC and bottle labels complete and legible? YES NO <br />b. Is the COC in agreement with samples received? (IDs, dates, tunes, no. of samples, no. yES NO <br />of containers, matrix, requested analyses, etc.) <br />~. Were airbills /shipping documents present and/or removable? DROP OFF YES NO <br />s. Are all aqueous samples requiring preservation preserved correctly? (excluding volatiles) N/A YES <br />9. Are all aqueous non-preserved samples pH 49? N/A ES NO <br />to. Is there sufficient sample for the requested analyses? YES NO <br />tt. Were all samples placed in the proper containers for the requested analyses? ES NO <br />u. Are all samples within holding times for the requested analyses? ~ NO <br />ts. Were all sample containers received intact? (not broken or leaking, etc.) YES NO <br />ta. Are all samples requiring no headspace (VOC, GRO, Rx CN/S, radon), headspace free? N/A YES NO <br />Size of bubble: _ < green pea- _> green pea <br />]s. Were samples checked for and free from the presence of residual chlorine? <br />(Applicable when PM has indicated samples ace from a chlorinated water source; note if field preservation with sodium N/A YES NO <br />tl»osulfate was not observed. <br />te. Were the samples shipped on ice? YE NO <br />]z Were cooler temperatures measured at 0.1-6.0°C? IR gun used*: #2 ~ oRn~nY YES NO <br />Cooler #: <br />Temperature (°C): ~ , f <br />No. of custody seals on cooler: e <br />DOT <br />sarveyf External µR/hr reading. ~ ~ _ <br />Atteptance ' <br />Information Background µR/hr reading: ~ <br />_ <br />Were external µR/ln readings <_ two times background and within DOT acceptance criteria? ~NO / NA (If no, see Form 008.) <br />If applicable, was the client contacted? YES / NO ~NA~Contact: <br />Project Manager Signature /Date: ..,~-~/j <br />*IR Gun #2: Oakton, SN <br />z/c~~ <br />•IR Gun #4: Oakton, SN 2372220101-0002 <br />Date/Time: <br />i <br />+r <br />Form 201r19.xls (1/13/06) ' <br />Page 1 of ~ <br />Additlonel InfOrmatiOn: PROVIDE DETAIIS BELOW FORANO RESPONSE TO ANY QUESTION ABOVE, EXCEPT #1 AND #16. <br />