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Paragon Ana/ytics <br />CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: ~t~ilu.~.~ Workorder No: ~ ~ ~~ ~ ~Z <br />ProjectManager: t%~ Initials: Date: //~/P"'O% <br />1. Does this project require any special handling in addition to standard Paragon procedures? YES N <br />2, Is pre-screening required per SOP 008? YES O <br />3, Are custody seals on shipping containers intact? N A YES NO <br />4, Are custody seals on sample containers intact? /A Y NO <br />5. Is there a COC (Chain-of-Custody) present or other representative documents? Y NO <br />6. Is the COC (if applicable) complete and legible? N/A Y NO <br />7, Are bottle IDs legible and in agreement with COC sample IDs? N/A Y NO <br />g. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A NO <br />9. Were airbills present and/or removable? N/A YE NO <br />l0, Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A YES N <br />I I, Are all aqueous non-preserved samples at the correct pH? N/A YES O <br />12, Is there sufficient sample for the requested analyses? YE NO <br />l3. Were all samples placed in the proper containers for the requested analyses? S NO <br />la. Are all samples within holding times for the requested analyses? NO <br />Is. Were all sample containers received intact? (not broken or leaking, etc.) S NO <br />t6. 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 wi0r sodium <br />thiosulfate was not observed,) <br />N/A <br />YES <br />NO <br />Is. Were the sample(s) shipped on ice? N/A Y NO <br />19. Were cooler temperatures measured at 0.1-6.0°C? N/A NO <br />*IR un used circle one : #2 - Oakton InfraPro II, SN2922500201-0066; #4 akton InfraPro II, SN23722201 - <br />Cooler #'s <br />Temperature (°C) ~- <br />No. of custod seals <br />s~rayt External µR/hr reading /Z <br />Acceptance _ <br />Intonnation BackgroundµR/hrreading /~~ <br />Were external µ12/hr readings 5 two times background and within DOT acceptance cti[eri YE.S 0 (If no, see Farm 008.) <br />If applicable, was the client contacted? YES !`~'C~ / NA Contact Name: <br />Project Manager Signature/ Date: / // l ~ <br />Date/Time: <br />~1 <br />Form 201 r'18.x1s (6/26104) <br />Page 1 of <br />Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QijEST19DYABOVEEXOEPT #I AND #2. <br />