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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Analyfics <br />Client: ~- Enn EX. Workorder No: O la O 20 S g <br />Project Manager: <br />JME <br />Initials: S t. Date: ~. ~} . p tp <br />t~ Does this project require any special handling in addition to standard Paragon procedures? YES NO <br />2. Are custody seals on shipping containers intact? ONE YES NO <br />3. Are Custody seals on sample containers intact? O YES NO <br />a. Is there a COC (Chain-of-Custody) present or other representative documents? YES NO <br />5 Are the COC and bottle labels complete and legible? YES NO <br />a. 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 />7. Were airbills /shipping documents present and/or removable? DROP OFF YES NO <br />$ Are all aqueous samples requiring preservation preserved correctly? (excluding volatiles) N/A YES ~O <br />9. Are all aqueous non-preserved samples pH 4-9? N/A (~ NO <br />to Is there sufficient sample for the requested analyses? YES NO <br />11 Were all samples placed in the proper containers for the requested analyses? 'ES NO <br />lz. Are al] samples within holding times for the requested analyses? © NO <br />13. Were all sample containers received intact? (not broken or leaking, etc.) YES NO <br />14. Are all samples requiring no headspace (VOC, GRO, Rx CN/5, radon), headspace free? N/A YES NO <br />Size of bubble: ` < green pea _> green pea <br />Is, 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 />thiosulfa[e was not observed. <br />t6. Were the samples shipped on ice? ~ YE NO <br />tz Were cooler temperatures measured at 0.1-6.0°C? IIL gun used*: #2 #4 O1~D YES NO <br />Cooler #: 1 <br />Temperature (°C): ~~ <br />No. of custody seals on cooler: <br />DOT <br />s°nreyi External µR/hr reading: ~~~ <br />Acceptance <br />Inf°imati°n Background µlUhr reading: (7 <br />Were external µR/hr readings <_ two times background end within DOT acceptance criteria? S / NO / NA (If ao, see Farm 008.) <br /> <br />If applicable, was the client contacted? YES / N / N Contact: / Date/Time: <br />Project Manager Signature /Date: Z is <br />*IR Gun #2: Oakton, SN 29922500201-0066. *IR Gun #4: Oakton, SN 2372220101-0002 <br />Form 201r19.xls (vls/os) Page 1 ofd <br />Additional Information: PROVIDE DETAIIS BELOW FORANO RESPONSE T07dVY QUESTION ABOVE,EXCEPT#I AND #16. <br />