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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Analytics <br />Client: ~_ E/lA ~)C. Workorder No: n (~ 12 p g~{ <br />Project Manager: J M F - Initials: ~1,_ Date: ~ • ~ ~ O (p <br />t Does this project require any special handling in: addition to standard Paragon procedures? i YES 0 <br />2.. Are custody seals on shipping containers intact? NNE YES NO <br />3. Are Custody seals on sample containers intact? ONE YES ~ NO <br />a. Is there a COC (Chain-of-Custody) present or other representative documents? ES NO <br />s. Are the COC and bottle labels complete and legible? YES NO <br />e. Is the COC in agreement with samples received? (IDs, dates; times, no: of samples, no: <br />of containers, matrix, requested analyses,-etc:) ES NO <br />~. Were airbills /shipping documents present and/or removable? oaor oFe ES NO <br />$. Are all aqueous samples requiring preservation preserved correctly? (excludingvolatiles) N/A YES NO <br />9_ Are all aqueous non-preserved samples pH 4-9? N/A ES NO <br />lo. Ts there sufficient sample for the requested analyses? YES NO <br />u.-Were- all samples placed in the proper containers for the requested analyses? YES NO <br />lz. Are all samples within holding times.for the requested analyses? NO <br />13. Were all sample containers received intact? (not broken or leaking, etc.) - ~ .. YE NO <br />1^ Are all samples requiring no headspace (VOC, GRO, Rx CN/S, radon), headspace free? <br />Size of bubble:. _ < green pea _>: green pea /A YES NO <br />ls. Were samples checked for and free from thepresence of residual chlorine? <br />(Applicable when PM bas indicated samples am from a chlorinated water source; note if field preservation with sodium ~ <br />thiosulfate was not observed: ~ - ~ - - - <br />/A <br />YES <br />NO - <br />16. Were the samples shipped on ice? YES NO <br />lr. Were cooler temperatures measured at0:1-6.0°C? >R gan nsea*: . #2 #4 oN D' NO <br />Cooler #: <br />Temperature (°C): Z• 0 <br />No. of custod seals on cooler: $- <br />DOT <br />s°na~ ExtemaLpR/lu reading: I'~ _ <br />Aaeptance - <br />mrormaron Background µR/lu reading: 1 '-~ <br />Were exteznal µR/hr readings < two times backginund~and widaa DOT acceptance criteria? YE / NO ! NA (If no; see Form 008.) <br />a. Addifional Inform1(a't~i1on:~~ PRO~VI~DE DETgILB,BELOW FORANO1RESPO1NSE TO ANY QUESTION/A~BOVE, EX/C~EPT #1 AND #16. <br />T r~An...[1De -+nA in.TA /f~A -nw.. /1~i lAJ L~ ~4n lnn r.nn.n.. ..G .1/ ~.- 11..1_ <br />k <br />Date/Time: <br />If applicable, was the client contacted? YES / NO / NA -Contact: ~ - <br />Project Manager Signature /Date: <br />"IR Gun #2: Oakton, SN 29922500201-0066. "IR Gun #4: Oakton, SN 2372220101-0002 <br />Form 201r19.xls ~(1/13/O6) <br />