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CONDTI'ION OF SAMPLE UPON RECEIPT FORM Paragon Anaiytics <br />Client: C t~~ /K ~ X Workorder No: O6~q~ 7C7O 3 <br />Project Manager: ,S / Initials: ~lj/~ Date: 7~oI-ob <br />t. Does this project require any special handling in addition to standazd Paragon procedures? YES <br />2. Are custody seals on shipping containers intact? O 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? I NO <br />s. Are the COC and bottle labels complete and legible? ~ NO <br />e. Is the COC in agreement with samples received? (IDs, dates, times, no. of samples, no. <br /> <br />of containers, matrix, requested analyses, etc.) S NO <br />~ Were airbills /shipping documents present and/or removable? DROP OFF NO <br />s. Are all aqueous samples requiring preservation preserved correctly? (excluding volatiles) ~ YES NO <br />e. Are all aqueous non-preserved samples pH 4-9? N/A YES <br />to. Is there sufficient sample for the requested analyses? ~ NO <br />11. Were all samples placed in the proper containers for the requested analyses? ~ 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.) ~ NO <br />la. Are all samples requiring no headspace (VOC, GRO, Rx CN/S, radon), headspace free? <br /> <br />Size of bubble: _ < green pea _> green pea ~ YES NO <br />ls. Were samples checked for and free from the presence of residual chlorine? <br /> (Applicable when PM has indicated samples aze from a chlorinated water sonrce; note if field preservation with sodium N/ YES NO <br /> thiosulfate was not observed. <br />16. Were the samples shipped on ice? YES <br />{{~~ <br />lz Were cooler temperattrres measured at 0.1-6.0°C? n2 gun used*: l#7J #4 ot~.ll-y ~S <br /> Cooler #: <br /> Temperature (°C): $ <br /> No. of custod seals on cooler: ~ <br /> DOT <br />s°rweYi External µR/Iv reading: ~ ~ <br /> Acceptance <br />Information Background µR/hr reading: ( 2 <br /> Were external µR/iv readings <_ two times background and within DOT acceptance criteria? NO / NA (If no, sce Fotm 008.) <br />Additional Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE, EXCEPT #1 AND #16. <br />l.G I ; x.,t ~,,,.,4. s C- O: f 4'11.1.. 5~ a.,.t. C- l: fi PIS t t..td .-,..~- ,,..:1- o~ ~H <br /> <br /> <br /> <br />If applicable, was the client contacted?/i'ES„(NO <br />~~..// ~ <br />Project Manager Signature /Date: <br />*IR Gun #2: Oakton, SN 29922500201-0066. <br />*IR Cru¢ #a: Oakton, SN 23'72220101-0002 <br />1. <br /> <br />Date/Time: <br />Form 201r19.xls (1/13/06) <br />f7ono ~ of t <br />