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Paragon Analytics <br />/C~ ONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: t •O.tv`¢,~C Workorder No: Q ~j j p O Y~ <br />Project Manager: ~"(-IVI.G Initials: .cJ Date: l0 - ~-n <br />1 Does This project require any special handling in addition to standard Paragon procedures? YES NO <br />2. Is pre-screening required per SOP 008? YES N <br />3, Are custody seals on shipping containers intact? N/ YES NO <br />q, Are custody seals on sample containers intact? N/ YES NO <br />s. Is there a COC (Chain-of-Custody) present or other representative documents? NO <br />6, Is the COC (if applicable) complete and -egible? N/A Y NO <br />7, Are bottle IDs legible and in agreement with COC sample IDs? N/A YE NO <br />g. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A YE NO <br />g, Were airbills present and/or removable? N/A YE NO <br />10. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A YES <br />1 t. Are all aqueous non-preserved samples at the correct pH? N/A YES O <br />t2. 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 />ta. 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 />I6. 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 with sodium <br />[hiosulfate was not observed) //~,~J <br />YES <br />NO <br />1s. Were the sample(s) shipped on ice? N/A NO <br />19. Were cooler temperatures measured at 0.1-6.0°C? N/A YES N <br /> *IR o used (circle one #2 - Oakton InfraPro II, SN2922600201-0066; #4 - Oakton InfraPro II, SN2372220101-0002 <br /> Cooler #'s <br />Temperature (°C) -Lb . <br />No. of custody seals <br />s~Navt External µR/lu reading <br />Acceptance <br />Information Background µR/hr reading 13 <br />Were external µR/lu readings 5 two times background and within DOT acceptance criteria? NO <br /> <br /> <br /> <br /> <br /> <br />If no, see Form 008.) <br />Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE EXCEPT #1 AND #2. <br />Sca•..B~eS r-ec-a.tv~ .s ciyrv+e.,r~,i®P/I1 vet /wa~~ ~ `lla°C <br />~ J0.n,.6}~CS # ~ ~ ~ ~ ~ /ItISSe~V Col aMP~ ~~ JNt^4 !`G CZI W/ (~.o i-CSCivp~ <br />~. l -kr a~.k Dresa/ tre si ...,o/es .~- t °r ~ n K o~~ <br />s SA~( ~ ~ ~ '~ ~ rC c~N.y~1 ~ i~ ff_ ~ ~ n_ e~ t se~r.u71t'l v-e~ ~w.~/~..~ <br />If applicable, was the ctien[ contacted? YE/S~/j~ / NA Contact Name: Date/Time: <br />Project Manager Signature/ Dat a~~! I D/~~~ <br />Form 201 rt S.xis (6126104) <br />Page 1 of <br />