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Paregon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: CervtQx WorkorderNo: _ (jc/o~0 9 N <br />Project Manager: ,~-'l/1E Initials: _ (f Date: $ fj <br />1. Does this project require any special handling in addition to standard Pazagon procedures? 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? ~ YES NO <br />5, Is there a COC (Chain-of-Custody) present or other representative documents? ~ NO <br />6, Is the COC (if applicable) complete and legible? N/A ® NO <br />~_ Are bottle IDs legible and in agreement with COC sample IDs? N/A ~ NO <br />g. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A ® NO <br />q. Were airbills present and/or removable? N/ NO <br />10. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) YES NO <br />u. Are all aqueous non-preserved samples at the correct pA? N/A ~ NO <br />1z. Is there sufficient sample for the requested analyses? ~E NO <br />1}. Were all samples placed in the proper containers for the requested analyses? ~ NO <br />ly. 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 />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 />l~ Were samples checked for and free from the presence of residual chlorine? <br />(Applicable when PM has indicated samples aze from a chlorinated water source; note if field preservation with sodium <br />[hiosulfate was no[ observed) <br />~ <br />YE$ <br />NO <br />lg, Were the sample(s) shipped on ice? N/A YES <br />19. Were cooler temperatures measured at 0.1-6.0°C? vt gnn n:aa*: #1 #2 N/A YES <br />'1A Gnn 712: Raytek SN SGPMSf12940} Cooler #'s 1 <br />flR Gun N2: Oakton, SN 2SCIR1201 Temperatttre ~*ti~Y,Aq^~ <br />No. of custody seals N~ri <br />oor <br />s°rvayi External p,R/lu reading Ill/ <br />Acceptance <br />mrormaopn Background µR/hr reading N~ <br />Were external µR/Iv readings <_ two times background and within DOT acceptance criteria? YES / NO (If no, see Farm 008.) <br />IF applicable, was the client contacted? 1'ES / NO / NA Contact Name: Date/Time: <br />Project Manager Signature/Date: _ ~ `8~~°j~~_ <br />`// <br />Form 201r18.xls (6/26/04) <br />Page 1 of I <br />