ML16293A368
Text
App E-Area 1 - COC Forms
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Pago;------ of GEL Chain of Custody and Analytical Request GEL L.sbo!'lllaries, L.L<:
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Project II:
20~0 Savago Raad GELQnoleif.:
- "See wv.rw.gcl.com fol' GEL'S Sample Aci.:eptance SOP**
Char!es1on, SC 29407 COCNnmbl)[!!l;. --*** *-*.. *- -*-- -.-. -
- GEL Work Order Number:
!'hone: (843) 536-!!171 PO Number; l'a:o;; <80\\ 766-1178 Client Name:
Phone#:
Sample Analysis Requested ISl (Fil I i11 !he numbei* of conlaincrs for each lest)
Project/Site Name:
Fax#:
Should
<-- Preservative Tyj)C (6) this sampl~ bo Address:
con1ldered I
Comments Collected by:
Send Results To:
Note: extra sample is
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Sump!"
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Code*>
f-1!rc-ml MotriA Rodi I;
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No Cirelc Dcliv..:rable: C of A I QC Su1t1marv I Lm1cl l I Level 2 I Level J I Level 4 Re11111rks: Are there any known hazards applicable to these.vamp/es? l{.ro, please list lhB hazardr Swnpl!) :CQll~~lion Iim~ Z1:ml.l Eastem Pocific Ccntr&l Other ___
M0tmtnin Clialn of Custody Slguiiturea Sample Shipping ~nd Delivery Derails ltc[;11q11ishttl l.ly {SigncJ)
Dnlc l'lmo RoociYcd by ($igned)
Dore Time GEL PM:
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PINK= CLIENT WHITE~ LABO RA TORY
ccf' 1 Page:---*--*- of GEL Chain of Custody and Analytical Request OEL Loborotories, LLC Project II:
2040 Savage Road GEL Quolc II: _..... *------*
- "Sec www.gcl.com for GEL's Sample Acceptance SOP**
Ch~rleston, SC 29407 COC Nmnbcr l'l:
GEL Work Order Number:
Phone: (S43) 556-8171 PO Number.
Falt: 11!4~) 766.11 ?S Client Name:
Phone#:
Sample Analysis Requested (51 (Fill in the number or conlainctll for ench test)
Project/Site Name:
Fux II:
Shot1h1
<.. Preservative Type: (6) this san1pl~ bo Address:
<Omldortil Comm cuts Collected by:
Send Rcsulls To:
Note: extra sample is
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No Circle Dclivcr~hlc'. C of A I QCSummary I Level [
- I I.eve! 2 ( Luvcl 3 I Lcvcl4 Remctrks: Ar11 them any !mmvn*hawrds applicable tu rhe.w samples? lfso, please list the hazard1*
Sil!np[i;; c~llci;ti~D Iim~ zgoc Ea stem l'3cilic Ccmral Other ----
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Onie Time Received by (~ign*d)
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Date: Sliirmed:
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WHITE~ LABO RA TOR.\\'
YELi.OW = F'ILE PINK~CUENT
App E-Area 1-Instrument Field Sheets
Instrument Field Response Check Log
- 1.
Instrument lnformatlon 1
Ratemeter:
Make/Model: k_c;f /._,~ ?-,;I<.:/ I-z.
Serial No. 2(...1..~ Lf I Cal. Due Date: I ;/o 3/ t:i..,,
Cal. Due Date: a;, /l~/o -
Detector 1:
Make/Model: [.1H /cJ11<.
1-f'-(. 11/
Bicron MlcroRem Meter:
. Serial No. Pie ;) fJ °6 '-I 2-9 Serial No.
i'./ e7
- 2.
Check Source Information:
/
source 1 lsotope:77JJ:3l Serial No.: 11 I Activity~,v. /
units:..A.-1 c.£..
Assay Date: !.!LJ!!!ro.
Response Acceptance Range (+/-20%): uRem/hr+20%__
uRem/hr-20%__
net cpm + 20% S3 7 7't1net cpm -20% *;r,s- ~
(;.
/' I??
r Source 2 lsotope:L.S Serial No.: 11Cf e <... 3-/Z.
Activity: & '7Z...
unlt~Assay Date:~
Response Acceptance R<inge (-+/*2rf'!a): uRem/hr+20%~-* _
uRem/hr~20%__
net cpm + 20"/o 13 ;i. 73 net cpm -20% g,'jJc/7 3.
Title:
12.J Date: !O/t-0~ Time: CJ'Y ! I I
- 4.
Site or Location:
Site/Job:
(
- I.J- /. 2,.,.
1 If:JU 7
~
GPS Coordinates (when requfred):
X-Coord: '7~
7-~
I c.-., ~
Location
Description:
.O~vi-'/" tPy C.~-;-
Y-Coord: &?f3v 4'1 1 at:..v l
Instrument Field Response2 Use Acceptance Criteria Remarks Rev 1 10/18/1~
Meter Bkg Bkg Counts Source Source Response
+/-20%
Inst.
Battery TI me Ambient Initials and Comments Cnt (cpmJ or Cnt (gross cpm or source ca lib.
Check Of Temp.
{add'l Info: Inst. Condition, etc.)
TI me uRem/hr)
TI me uRem/hr) gross cpm current
{V/N) check (oF) or uRem/hr (Y/N)
(Y/N}
Ratemeter /,t}
7 I l/-Cj
/. c)
C?-? ;c)
\\.(
v y
O'j.'Z.~
(,.,_?. 7"
'5.c. fa~ ~J.1 c.clv1 c..r ***.J~
Rate meter /.0
- 7 3l(t/
f' c.)
9 !y '/7 y
v y
/I: 10 t-V. '-lo
/]p ~ _:
~ ~- -
~J 'tr Rate meter Rate meter Bicron NA 7.D NA Y.f@~O y
'(
y Ot;-.' J/
Bicron NA
'7-0 NA
~/<"9.,D y
v
./
IJJ~DO
~
Sieren NA NA Bicron NA NA
- 1.
Instrument designated check source Is l!sted on callbrat!on sticker. Record check source response (net cpm) prior to field deployment for all check sources be\\ng used.
- 2.
Source and Background count rate should be determined from the average of three statfc*counts at the same location. Repeat counts should be within 20%. If count r<1te diverges significantly, perform additional counts to evsluate instrument stability I
~ns
~W T~K...
~~VJCE'lli' Rev 110/18/15 I I I
- 1.
Instrument lnformation1 Ratemeter:
Make/Model: L. vOl..-vll-'\\ 21-YI~ Z Detectorl:
Make/Model: l vji:,.,;,111... t.; 1l*t<-..,
Bicron MicroRem Meter:
- 2.
Check Source Information:
Instrument Field Response Check Log Serial No. 2(o2 l '.$1 Serial No. ff-Ji 11 ;?. I Serial No. A J. ;:!. '1 IA.
Cal. Due Date: 0{ 2. i1 t,.
Cal. Due Date: I?/ '1/il~
Source 1Isotope:1). 1.. 5 ~ Serial No.:
JI(.,,,
Activity: ~
units:~
Response Acceptance Range (+/-20%): uRem/hr+20%__
uRem/hr-20% __
Assay Date:~-, o net cpm + 20% 219 lb..* net cpm *20% J 5' 2 fr-/
Source21sotope: Ls /°3>/
Seria1No.:,f7[;'Jj~.. 'f$"
Activity;
- v.2..
units:µ</_;. Assay Date: Li.2d10 Response Acceptance Range (+/-20%); uRem/hr +20% __
u8em/hr *20% __
net cpm + 20%' / 3 3 7 s net cpm -20% f? '11 7
- 3.
Technidan/Worker Performing Checks:
Name: Sil:Vif K'1.vS11i.<iV
Title:
fC.T
- 4.
Site or Location:
Site/Job:.--'A_,_* _,,,_R..::.<:'.l-1-'-'-..1.I _______
GPS Coordinates (when required):
X-Coord: N !.(2 °,;i ") 1 ( /. \\"
I Instrument Field Response2 Meter Bkg Bkg Counts Source Source Response
+/-20%
Date: 10f n!i) Time: uJ'Y*{
Location Descripti on:__.t!/.=......'t..,*
5'""f~f...
7 1"'""0_!1'---------
Y-Coord: l..,J Cl")[" 7'1 '"(<, <"
Use Acceptance Criteria Remarks Inst.
Battery Time Ambient Initials and Comments Cnt (cpm) or Cnt (gross cpm or source Calib.
Check Of Temp.
{add'! Info: inst. Condition, etc.)
Time uRem/hr)
Time uRem/hr) gross cpm current
{Y/N) check (oF}
oruRem/hr (Y/N)
(Y/N)
I m}IJ f! Ifs-J m11J I 1 M'J.
Ratemeter y
7' y
Dl't'i
. l(/. "!
'fl.. Z H.
Ratemeter / mrr./
Vt/<(
J 1111,...I fl t;t.<
y y
~i O\\**rt \\./
'fl.'].
( ( /J)
R.atemeter ),.n1tJ 7 (..l £,
J ll'll*V
/90J'f'
'/
y y
l'tl<
(?.I fl,?. n Ratemeter I r m11v IG!.>-b. I v1:"-'
J1o;v
'1 t
y J'{(!/
'{q I t~ 1n
' Ratemeter I,.,1,,J 1 ],f'1 j ;11 //\\J J 15D"(
v y
'/
isl(
<ff"_ f lh 1.~L
, Ratemeter I n-1 :,J ""Hrt'1
) /YllJi/
/D f'tf If y
y y
I<;;{
- ,t'. g Cs* 1 ~'
Bicron NA NA JI v
,y y
D£*1i,-'
'if'.(1 Bicron NA t~
NA IR
'-i y
I
/'it*:/'
{'I. I Bicron NA
~
NA Ix y
y y
I '>.I *)""
(i'- ~
- 1.
lnstrument designated check source ls listed on calibration sticker. Record check source response (net cpm) prior to field deployment for all check sources being used.
- 2.
Source.and Background count rate should be determined from the average of three static counts at the same location. Repeat counts should be within 20%. If count rate diverges significantly, perform additlonal counts to evaluate instrument stability l
i I
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