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CONDITION OF SAMPLE UPON RECEIPT FORM <br />Client: C EM E' <br />Project Manager: J M E <br />Paragon Analytics <br />Workorder No: n (p Q( (y ~~f <br />Initials: Date: ~~.p <br />1. Does this project require any special handling in addition to standazd Pazagon procedures? I YES ~NO <br />z. 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 />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. YES NO <br />of containers, matrix, requested analyses, etc.) <br />7 Were airbills /shipping documents present and/or removable? DROP OFF YES NO <br />a. Are all aqueous samples requiring preservation preserved correctly? (excluding volatiles) N/A YES INO <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 />1t. Were all samples placed in the proper containers for the requested analyses? 'E~S 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 />1<. Are all samples requiring no headspace (VOC, GRO, Rx CN/S, radon), headspace free? <br />N/A <br />YES <br />NO <br />Size of bubble: ~ < green pea _> green pea <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 ff field preservation with sodium N/A YE$ NO <br />thiosulfate was not observed. <br />la. Were the samples shipped on ice? YE NO <br />lz Were cooler temperatures measured at 0.1-6.0°C? m gun naea•: #2 #4 or~rLDV YES NO <br />Cooler #: ~ _ <br />Temperature (°C): ~_ <br />No, of custody seals on cooler: o <br />oor <br />s°rveyr - Extema] µR/hr reading: (~ <br />Acceptance - <br />mroa°auo° Background µR/hr reading: <br />Were ex[emal µR/hr readings 5 two times background and within DOT acceptance crit 'a? YES / O / NA (If no, sec Form 008.) <br />Additional Informafion: PROVIDE DETAILS BELOW FOR A NO RESPONSE T6,oAlY.eCESTION ABOVE, EXCEPT #1 AND #16. <br />+r <br />If applicable, was the client contacted? YES / NO .(NA/ Contact: ~ ~1 /~ DatefPime: <br />Project Manager Signature /Date: ~ rS~ -[ ~ "~ . <br />•IR Gun #2'. Oakton, SN 29922500201-0066. !IR Gun #4: Oakton, SN 2372220101-0002 <br />Form 201r19.x15 (1!13!06) <br />Page 1 of _~ <br />