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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Analytics <br />Client: C Ern EX Workorder No: ~G n $ O ~ I <br />Project Manager: J M E <br />Initials: S I•, Date: $ • 3 '4 (o <br />1 Does this project require any special handling in addition to standazd Pazagon procedures? YES NO <br />2. Are custody seals on shipping containers intact? ONE YES NO <br />3. Are Custody seals on sample containers intact? YES NO <br />a. Is there a COC (Chain-of-Custody) present or other representative documents? YES NO <br />s Are the COC and bottle labels complete and legible? YES NO <br />6' Is the COC in agreement with samples received? (IDs, dates, times, no. of samples, no. <br />of containers, matrix, requested analyses, etc.) YES NO <br />7 Were airbills /shipping documents present and/or removable? DROP OFF YES NO <br />x. Are all aqueous samp]es regniring preservation preserved correctly? (excluding volatiles) N/A YES <br />9. Are all aqueous non-preserved samples pH 4-9? N/A ®S NO <br />]e. 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 />12. Are all 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 />la. Are all samples requiring no headspace (VOC, GRO, Rx CN/S, radon), headspace free? <br />Size of bubble: _ < green pea _> green pea N/A YES NO <br />ls, 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 />thiosulfate was aot observed. <br />N/A <br />YES <br />NO <br />16. Were the samples shipped on ice? - YE NO <br />t? Were cooler temperatures measured at 0.1-6.0°C? IR gun used*: #2 #4 oMD ~ NO <br />Cooler #: I <br />Temperature (°C): I .O <br />No. of custody seals on cooler: '~ <br />DOT <br />s°n,ayi External µR/hr reading: I Z <br />AxePtance ' <br />Information Background µR/hr reading: I Z <br />Were external yR/hr readings 5 two times background and within DOT acceptance criteria? YES NO / NA (If no, see Fonn 008.) <br />Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE, EXCEPT #1 AND #16. <br />+~- <br />7 <br />® 1Jo CO~1PS.~'rr)tn -Eiwtes ovt c~r~ or ~o{fle5 <br />'IR Gun #2: Oakton, SN 29922500201-0066. <br /> <br />*IR Gun #4: Oaktoq SN 2372220101-0002 <br />2;~1i3~-r, <br />Form 2D1rt9.xls (1/13/06) ' <br />Page 1 of ~ <br />'DA?E ON COC $rITT(.•~S i_~hlb •~Ei„T_wl JSCrI ~ATF SS '~~J~IOCp <br />. _~{..QtntF V F R '(11F SAMPLES Ott F.'t;F 12ELZ E,V F.D O N ~4_(n <br />