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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: ~~,m p.p Workorder No: 0 S ~ ~ ~ ~S <br />r <br />ProjectManager: _~1NE Initials: ~'~'YV Da[e: y 7 <br />i. Does this project require any special handling in addition to standard Paragon 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 />7, Are bottle IDs legible and in agreement with COC sample IDs? N/A S NO <br />g. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A S NO <br />9. Were airbilis present and/or removable? N/A NO <br />to. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A YES ~ <br />l 1. Are all aqueous non-preserved samples at the correct pH? N/A YES <br />12. Is there sufficient sample for the requested analyses? NO <br />13. Were all samples placed in the proper containers for the requested analyses? ~ NO <br />14, Are all samples within holding times for the requested analyses? ~ NO <br />ts. Were all sample containers received intact? (not broken or leaking, etc.) ~F NO <br />16. Are all samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon), <br />headspace free? Size of bubble: _ < green pea _> green pea ~ 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 5eld preservation with sodium <br />thiosulfate was not observed.) <br />N/ <br />YES <br />NO <br />ig, Were the sample(s) shipped on ice? N/A S NO <br />19. Were cooler temperatures measured at 0.1-6.0°C? N/A NO <br />•IR o used circle one #2 - Oakton InfraPro II, SN2922500201-0066; #4 - Oakton InfraPro II, SN2372220101-0002 <br />Cooler #'s { <br />Temperatttre (°C) <br />No. of custody sealsC~ <br />s~Neyi External µR/hr reading 1 `~ <br />Hcceptance <br />imom,aw° Background µR/hr reading .3 <br />Were eztetnal µR/hr readings S two times background and within DOT accepmnce cri[eri ~' / NO (if no, see Form 008.) <br />AOOAI[IOnal lIttorma[lo/n~: PROVIDE DErA1LS EELOW FOR A NO RESPONSE TO ANY QUESTIBN ABOVE EXCEPT #I AND #2. <br />`'rt~~ Sw"r~S 14~r M2-~.~c cthaj„cec ~¢c'r~ ~r,pieS~rUt'fi/ ~.:I~ ~ <br />rc <br />If applicable, was the client contacted? YES / NO (SDirY Contact Name: Date/Time: <br />Project Manager Signature/ Date: ' ~ -:. ~ - / / ~~ G' <br />~. <br />Form 201rt6.xls (6126104) <br />Page 1 of _ <br />