HYDRO28940

• Permit No: M1977208
• IBM Index Class Name: Hydrology
• Doc Date: 6/13/2005
• Doc Name: water sample and results levels
• From: paragon analytics
• To: dmg
• Media Type: D
• Archive: No

Paragon Analytics
CONDITION OF SAMPLE UPON RECEIPT FORM
Client: (' ~~ ~,~ Workorder No: (~ 5C~ S I
Project Manager: J (VI ~ Initials: ~_ Date: 5 • 14 ~ O5
1, Does this project require any special handling in addition to standazd Paragon procedures? YES
2. Is pre-screening required per SOP 008? YES
3, Are custody seals on shipping containers intact? ! YES NO
a. Are custody seals on sample containers intact? /A YES NO
$, Is there a COC (Chain-of-Custody) present or other representative documents? YES NO
6. Is the COC (if applicable) complete and legible? N!A YES NO
7, Are bottle IDs legible and in agreement with COC sample IDs? N!A YES NO
8, Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A YES NO
9. Were airbills present and/or removable? NJA YE NO
10. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) / YES NO
11. Ate all aqueous non-preserved samples at the correct pH? NfA YE NO
12. Is there sufficient sample for the requested analyses? NO
13. Were all samples placed in the proper containers for the requested analyses? ~ NO
la. Are all samples within holding times for the requested analyses? S NO
15. Were all sample containers received intact? (not broken or leaking, etc.) YES NO
1s. Are all samples requiring no headspace (volatiles, reactive cyanidelsulfide, radon),
headspace free? Size of bubble: _ < green pea _> green pea N1A YES NO
17 Were samples checked for and free from the presence of residual chlorine?
(Applicable when PM has indicated samples are from a chlorinated water source; note iF field preservation with sodium
thiosulfate was not observed.)
N/A
YES
NO
1g. Were the sample(s) shipped on ice? N/A YES NO
19. Were cooler temperatures measured at 0.1-6.0°C? ~ NlA YES NO
*IR un used (circle one) : 2 - Oakton InfraPro II, SN2922500201-0066; #a - Oakton InfraPro II, SN2372220101-0002
Cooler #'s
Temperature (°C) 3, lp
No. of custody seals $
s~nay/
Acceptance
~~°~°° External µR/hr reading

Background µRAtr reading ( Z
Were external µRlhr readings S two times background and within DOT acceptance criteria? $ / I~IO

If no, see Form 008.)
If applicable, was the client contacted? XES 7 NO / Contact Name:c~ ~q.~, DatelTime:
Project Manager Signature) Date: ~ ~ ` ""/
Porm 2otrta.xfs {snsroal Page 1 of ~
Additional Information: PROVIDE DETAILS BELOW FORANO RESPONSE TO ANY QUES ABOVE EXCEPT #1 AND#2,