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Paragon Analytics <br />CONDITION OF SAMPLE UPON RECEffT FORM <br />Client: ~ ~ytnClc WorkorderNo: ~ K ~l ~ p7 <br />Project Manager: -rte ~ Initials: ~~ Date: f /' 3-p <br />1. Does this project require any special handling in addition to standard Pazagon procedures? YES N <br />2. Is pre-screening required per SOP 008? YES NO <br />3. Are custody seals on shipping containers intact? N/ YES NO <br />q. Are custody seals on sample containers intact? N/ YES NO <br />s. Is there a COC (Chain-of-Custody) present or other representative documents? NO <br />a. Is the COC (if applicable) complete and legible? N/A NO <br />7, Are bottle IDs legible and in agreement with COC sample IDs? N/A NO <br />g, Is the COC in agreement with samples received? (# of samples, # of containers, matrix) N/A NO <br />y, Were airbills present and/or removable? N/A NO <br />10. Are all aqueous samples requiring preservation preserved correctly? (excluding volatile organics) N/A S NO <br />.1i, Are all aqueous non-preserved samples at the correct pH? N/A YES NO <br />1z. Is there sufficient sample for the requested analyses? YES NO <br />l3. Were all samples placed in the proper containers for the requested analyses? YE NO <br />14. Are all samples within holding times for the requested analyses? NO <br />ls. Were atl sample containers received intact? (not broken or leaking, etc.) NO <br />16. Are all samples requiring no headspace (volatiles, reactive cyanide/sulfide, radon), <br />headspace free? Size of bubble: < green pea _> green pea N/ YES NO <br />17 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 preservaticn with sodium <br />thiosulfate was not observed.) <br />YES <br />NO <br />lg. Were the sample(s) shipped on ice? N/A NO <br />l9. Were cooler temperatures measured at 0.1-6.0°C? N/A YE NO <br />*IR n used (circle one) : #2 - Oakton InfraPro II, SN2922500201-0066; 4 - Oakton InfraPro II, SN2372220101-0002 <br />Cooler #'s ~ <br />Temperature (°C) ~ , F( ~ <br />No. of custody seals <br />s~Neyi External µR/tlr reading <br />Acceptance I~ <br />Infotmalian Background µR/lu reading <br />Were ex[emal µR/hr readings < two times background and within DOT acceptance criteria? YES / NO (If no, see Form 008.) <br />AQAi/tional Information: PROVJJIDE DETAILS BELOW FOR A NO RESPONSE T/O ANpY QUEST/IOt<YABOVEFXCEPT #1 AND #2. <br />~ClMA7IlBS ~/ ~ ~oC rec.al~ ItinD/2SGppI'V`~~~fil 'tDY//K1SAS0/Y~ 1ML72f.GS GdN/~,GL,d.Pd <br />~. ~ ~ r)- PcC.ser v~C OTI.n r ~]] /.1 vlAL'~nO~.D. Jk.~,o~GC ~ ~ -~y_~ _ Sk.,.....It 1 -o <br />If applicable, was the client contacted? YES / NO / NA Contact Name: <br />Project Manager Signature/ Date: ~~ ~(/3~ / <br />Form 201r18.xls (6l26I04) <br />Date/Time: <br />Page 1 of! <br />