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CONDITION OF SAMPLE UPON RECEIPT FORM Paragon Analytics <br />Client:~~~.~(`~ WorkorderNo: C~~'C22'~- <br />Project Manager: ~ , [ Initials: ~~ Date: q'JiF-06 <br />t. Does this project require any special handling in addition to standazd Pazagon procedures? YES <br />2. Are custody seals on shipping containers intact? O YES NO <br />I. Are Custody seals on sample containers intact? YES NO <br /><_ Is there a COC (Chain-of-Custody) present or other representative documents? YE NO <br />s. Are the COC and bottle labels complete and legible? NO <br />6. Is the COC in agreement with samples received? (IDs, dates, times, no. of samples, no. <br /> <br />of containers, matrix, requested analyses, etc.) yES NO <br />T Were airbills /shipping documents present and/or removable? DROP OFF YES NO <br />e. Are all aqueous samples requiring preservation preserved correctly? (excluding volatiles) YES <br />9. Are all aqueous non-preserved samples pH 4-9? N/A ~L NO <br />to. Is there sufficient sample for the requested analyses? NO <br />il. Were all samples placed in the proper containers for the requested analyses? S NO <br />12. Are all samples within holding times for the requested analyses? E 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 N/A YES NO <br />]s. 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 / YES NO <br />thiosulfate was not observed. <br />16. Were the samples shipped on ice? NO <br />n. Were cooler temperatures measured at 0.1-6.0°C? D2 gun used*: #2 #4 p~NLy YES NO <br />Cooler #: <br />Temperature (°C): 2-~ <br />No. of custody seals on cooler: <br />DOT <br />sa~yi External µR/lu reading: ~ y <br />Acc°PWnce 77 <br />mrortnatin" Background µR/hr reading: ~ ~r <br />Were eztemal pR/hr readings 5 two times background and within DOT acceptance cti[eri YES O / NA (If no, see Fotm 008.) <br />Information: PROVIDE DETAILS BELOW FOR A NO RESPONSE TO ANY QUESTION ABOVE, EXCEPT #1 AND #16. <br />,-,.mod ;,~ „ 6F 12. <br />2, <br />If applicable, was the client contacted? YES / N Contact: Date/Time: <br />Project Manager Signature /Date: 29 Dl0 <br />'IR Gun #2: Oakton, SN 2 9922 5 002 01-006 6 *IR Gun.Y4: OaMon, SN 2372220[02-0002 <br />Form 2D1r19.xls (t/13106) <br />