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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Analytics <br />Client: ~X' Workorder No:~-~~~ d (~ [ IOtjR <br />ProjectManager: ~, ~, Initials: /,~/~/ Date: f I-/-a6 <br />t. Does this project require any special handling in addition to standard Paragon procedures? I YES NO <br />2. Are custody seals on shipping containers intact? NO YES NO <br />3. Are Custody seals on sample containers intact? NO YES I NO <br />4. Is there a COC (Chain-of-Custody) present or other representative documents? ES NO <br />s. Are the COC attd bottle labels complete and legible? Y S NO <br />6. Is the COC in agreement with samples received? (IDs, dates, times, no. of samples, no. yES NO <br />of containers, matrix, requested analyses, etc.) <br />~. Were airbills /shipping documents present and/or removable? oaoP oPP S NO <br />s. Are all aqueous samples requiring preservation preserved correctly? (excluding volatiles) N/A YES 0 <br />9. Are all aqueous non-preserved samples pH 4-9? N/A YES N <br />lo. Is there sufficient sample for the requested analyses? ~I S~ NO <br />t t. Were all samples placed in the proper containers for the requested analyses? NO <br />lz. Are all samples within holding times for the requested analyses? NO <br />13. Were all sample containers received intact? (not broken or leaking, etc.) S NO <br />te. Are all samples requiring no headspace (VOC, GRO, Rx CN/S, radon), headspace free? <br /> <br />Size of bubble: _ < green pea _> green pea A YES NO <br />ts. 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 N A YES NO <br />thiosulfate was not observed. <br />]6. Were the samples shipped ott ice? YES NO <br />n. Were cooler temperatures measured at 0.1-6.0°C? IR gun used": #Z #4 o~cv NO <br />Cooler #: <br />Temperature (°C): ~, (7 <br />No. of custody seals on cooler: ~ <br /> _ <br />ooT <br />survayl Extemall.tR/hrreading: ~2- <br /> Acceptance <br /> Information $ackground p.R/hr reading: I <br /> Were external µR/lu readings 5 two times background and within DOT acceptance criteria? S NO / NA (If no, see Form 008.) <br />~~ <br /> <br />Add~iJtional Information: PROM/D,E DET//~ILS(BELOW FOAJ/+NO RESP/ONSE TO ANY QUESTION ABOVE, EXCEPT #1 AND #16. <br />'~ /"I~yff 4h. -~o ~iG -~f'fe~CU tv/ 1~rsf~C/ !`t' /4h. <br />Z, ~ -n.>L i S a~ N ~f 17 <br />If applicable, was the olient contacted? YES / NO /~ Contact: Date/Time: <br />Project Manager Signature /Date: <br />•IA Gun #2: Oaktoq SN 29922500201-0066. 'IR Gmt #4: Oakton, SN 2 72220101-0002 <br />Form 201r19.xls (1/'13/06) Page 7 Of i <br />