HYDRO30060

• Permit No: M1977208
• IBM Index Class Name: Hydrology
• Doc Date: 2/8/2006
• Doc Name: Water Sample Results and Level
• From: CEMEX Inc.
• To: DMG
• Media Type: D
• Archive: No

Paragon Analytics
CONDITION OF SAMPLE UPON RECEIPT FORM
Client: [wt~)[ WorkorderNo: OS 121 al q
Project Manager: J /y1 E Initials: St- Date: ~ z • 3 0 • p5
1. Does this project require any special handling in addition to standard Paragon procedures? YES ~ 0
2. Is pre-screening required per SOP 008? ~ YES ~ NO
3. Are custody seals on shipping containers intact? N/A YES NO
4. Are custody seals on sample containers intact? /A YES NO
5. Is there a COC (Chain-of-Custody) present or other representative documents? ES 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 'ES NO
g. Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A ES NO
q. Were airbills present and/or removable? N/A ES NO
t0. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A ES~ NO
1l. Are all aqueous non-preserved samples at the correct pH? N/A ES NO
Iz. Is there sufficient sample for the requested analyses? E5 NO
13. Were all samples placed in the proper containers for the requested analyses? Q NO
I4, Are all samples within holding times for the requested analyses? YES NO
15. Were all sample containers received intact? (not broken or leaking, etc.) E NO
16. Are all samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon),
headspace free? Size of bubble: _ < green pea > green pea N/ YES NO
17 Were samples checked for and &ee from the presence of residual chlorine?
(Applicable when PM has indicated samples an; from a chlorinated water source; note if field preservation with sodium
thiosulfate was not observed)
/A
YES
NO
I8. Were the sample(s) shipped on ice? N/A ~ NO
19. Were cooler temperatures measured at 0.1-6.0°C? N/A E NO
*IR un used (circle one #2 - Oakton InfraPro II, SN2922500201-0066; #4 - Oakton InfraPro II, SN23722201 01-0002
Cooler #'s 1
Temperature (°C) y~.p
No. of custody seals ~~
oor
s°rverf External µR/hr reading ~~
Acceptance
Information Background µR/hr reading _~~
Were external µR/hr readings 5 two times background and within DOT acceptance criteria? .S / O

f no, see Foan 008.)
If applicable, was the client contacted? YES / NO
Project Manager Signature/ Date:
Form 201r18.xls (6126104)
Contact Name: Date/Time:
2/.3 0/6S
Page 1 of
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Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE EXCEPT #1 AND #2.