HYDRO29622

• Permit No: M1977208
• IBM Index Class Name: Hydrology
• Doc Date: 7/13/2005
• Doc Name: water sample results and level
• From: cemex
• To: dmg
• Media Type: D
• Archive: No

Paragon Analytics
CONDITION OF SAMPLE UPON RECEIPT FORM ,/
Client: C E~E,~ WorkorderNo: DSO,-(Q (t'I15
Project Manager: ,J /N ~ Initials: S~- Date: • ( • O
1, Does this project require any special handling in addition to standard Pazagon procedures? YES
2. Is pre-screening required per SOP 008? YES
3. Are custody seals on shipping containers intact? / YES NO
4, Are custody seals on sample containers intact? /A S NO
s. Is there a COC (Chain-of-Custody) present or other representative documents? s~ (o ) 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
g, Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A YES NO
9. Were airbills present and/or removable? N/A YE NO
10. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) / YES NO
t 1. Are all aqueous non-preserved samples at the correct pH? N/A YE NO
12. Is there sufficient sample for the requested analyses? YE NO
13. Were all samples placed in the proper containers for the requested analyses? ~ NO
14. Are all samples within holding times for the requested analyses? S NO
15. Were all sample containers received intact? (not broken or leaking, etc.) YE NO
16. Are all samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon),
headspace free? Size of bubble: _ < green pea > green pea N!A YES NO
17 Were samples checked for and free from the presence of residual chlorine?
(Applicable when PM has indicated samples are fiom a chlorinated water source; note if field preservation with sodium
tltiosulfate was not observed J
N/A
YES
NO
lg, Were the sample(s) shipped on ice? N/A ~ YES NO
I9. Were cooler temperatures measured at 0.1-6.0°C? NiA YrS NO
*IR un used circle one) : 2 - Oakton InfraPro R, SN2922500201-0066; #4 - Oakton InfraPro II, SN2372220101-0002
Cooler #'s
Temperature (°C) 2 - Z
No. of custody seals $
oor
sarveyl External µR/hr reading 1 t-
Aaeptanco
mrormauoa Background µIi/hr reading -J Z -
Were external µR/Iv readings 5 two times background and within DOT acceptance criteria? $ NO (If no, see Form OOg.)
P
If applicable, was the client contacted? Y~/ NO / NA Contact Name: ~~ iq„~L~/ Date/Time: ~ ~.:~ ~j
Project Manager Signature/ Date:
~ 2~ ~
''
i
Form 201r18.xls (6126/04)
Page 1 of ~
Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTTON ABOVE EXCEPT #I .AND #2.