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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Analytics <br />Client; - ~.EnnEy~ WorkorderNo: ~G ~2,I" <br />Project Manager; J M E Initials: ~'/ Date: / 2 - (S o 6 <br />1. Does this project require any special handling in addition to standazd Paragon procedures? I YES NO <br />2. Are custody seals on shipping containers intact? ONE YES NO <br />s. Are Custody seals on sample containers intact? O YES NO <br />< Is there a COC (Chain-of-Custody) present or other representative documents? YES NO <br />s. Ate 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 />~. Were airbills /shipping documents present and/or removable? DROP OFF YES NO <br />s. 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 />lU. 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 />is. 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/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 not observed <br />N/A <br />YES <br />NO <br />16. Were the samples shipped on ice? YE NO <br />17. Were cooler temperatures measured at 0.1-6.0°C? ut gun used*: #2 #4 o~NLD YES NO <br />Cooler #: ~` <br />Temperatlue (°C): d, ~ <br />No. of custody seals on cooler: Q <br />ooT <br />s°neyi External itR/hr reading: ~ S <br />AccePtence ' <br />mrormafl°n Background µR/hr reading: <br />Were external µR/hr readings 5 two fines background and within DOT acceptance criteria? S NO / NA (If no, see Form DOB.) <br />Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE, EXCEPT #1 AND #16. <br />dr <br />If applicable, was the client contacted? YES / N ' N Copia t: Date/Time: <br />Project Manager Signature /Date: (Z~ ~~~ CTS <br />`IR Gun #2: OaMon, SN 29922500201-0066. "IR Gun #4: Oakton, SN 2372220101-0002 <br />Form 201rt 9.x15 (1/13/06) ' <br />Page 1 of ~ <br />