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{{#Wiki_filter:App E-Area 1 -COC Forms | {{#Wiki_filter:App E-Area 1 - COC Forms | ||
* Non111d Samplo, TD* Trip FO | |||
* l'iold Duplk*la, Ell* llquipmtn\ MS | ~p\0\ ~f>rYA/ t P a g o ; - - - - - - of Project II: | ||
GEL Chain of Custody and Analytical Request GEL L.sbo!'lllaries, L.L<: | |||
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) | |||
Should Project/Site Name: Fax#: this <-- Preservative Tyj)C (6) sampl~ bo Address: con1ldered I | |||
Comments Collected by: Send Results To: Note: extra sample is | |||
'Tm1c required for sample , | |||
*D1u0: CnUecl~il C"a1:\~1,'l.f, QC Fiol~ Sump!" rsc specific QC MotriA Rodi f-1!rc-ml I; Sample ID (1Plll*d~*)1') | |||
(Mllll*ry) Code*> ('j OAC:U lt*gu | |||
" For <:v11111oslle.\' ... J11dic:alf' :Jtan a11ti s/u1> 4otelthne !lihn1m) J:1ttfl ber <1 I. 3. C.. I l~-'Z,H~ Of*.?jO N 1,3,c..,Z. 10--t,H S- '1:50 ('.l | |||
/, '3' (...., '3 1u--i,\-'\$ )0'*00 N i 3. (...,6 I 10-1.l-f~ Cf:"-/o Fi> | |||
Ii 3, c. {d ru~'1\-1~ Cf '-$15" i;:,D | |||
*3 I\ t../, k,, I 1n-1Hs (Q'.q:;; t1 3 I \ o L{if!. l f r6 '""'1..1--1<; 11._c£ ~ | |||
~.l,l-/if?-*3 IO-L.1--t'< 11*.~,i:; tt.l .* | |||
3, /, Lf ,e,1-f lb-&H< W;1-.0 N TAT R~aucslcd: NormQl' Rush: Succifii: {Sub.it*t1 '" s.... b~'E*} I!'ax Rcsul1s: Yez I No Cirelc Dcliv..:rable: C of A I QC Su1t1marv I Lm1cl l I Level 2 I Level J I Level 4 Re11111rks: Are there any known hazards applicable to these .vamp/es? l{.ro, please list lhB hazardr Swnpl!) :CQll~~lion Iim~ Z1:ml.l Eastem Pocific Ccntr&l Other _ _ _ | |||
M0tmtnin Clialn of Custody Slguiiturea Sample Shipping ~nd Delivery Derails ltc[;11q11ishttl l.ly {SigncJ) Dnlc l'lmo RoociYcd by ($igned) Dore Time GEL PM: | |||
I 1 McJl1ud of Sh[omcnt: Dale Shinced: | |||
2 2 Airbi!lll: | |||
) 3 Alrbill #: | |||
q 'Ch11llt ofCu~c.iy Numbizr;.., Clittil De.u::rmlncd F/Jr Lah l!~~riM11g Us~ 011/y l.) QC.- t'cd~o: N | |||
* Non111d Samplo, TD* Trip ill*n~. FO | |||
* l'iold Duplk*la, Ell* llquipmtn\ nl*ll~, MS | |||
* M*rri< Spiko.Semplo, MSD | * M*rri< Spiko.Semplo, MSD | ||
* Splko Durl<<olo S.mplo, G | * M~:ti* Splko Durl<<olo S.mplo, G | ||
* 011>b, C | * 011>b, C | ||
* 3) f'tld f1lmtd: For (iquld lnd!c.DJc: wiU1:i .. s11mpt:: wc.s. fic.td or .. H .. ror sornpJc: wa1 riot Hotd rmetvd. Crr.ttody Set1! Jntaa? 4. l DW=Drfa'Ming W;tlcr, GW*Grou111.h...,t1k!r, S\V=SurCecu \Vorcr, \Y\Y-aW"$h: \Vlliti:fJ ML::rlA13.c ."iD=-S\!dim.::al, | * C~mp,~ito | ||
* 3, 60/U!JllOOA -I). C1wh>r T<Jmp: 6.) U/\ | : 3) f'tld f1lmtd: For (iquld m~1rlw1i, lnd!c.DJc: wiU1:i .. V.foryIJi111~ s11mpt:: wc.s. fic.td rd,~rtd or .. H .. ror sornpJc: wa1 riot Hotd rmetvd. Crr.ttody Set1! Jntaa? | ||
* Uy1f ['lttl1lwiic: Nt""' N'i1ric Add, SH .. Sodmrn SA ... Sulfu1ic Acid, A,.\ .. A:trnb;i;-HX."" | 4.l M::a!ri~ CCldi:~ DW=Drfa'Ming W;tlcr, GW*Grou111.h...,t1k!r, S\V=SurCecu \Vorcr, \Y\Y-aW"$h: \Vlliti:fJ Wi::\Vo111~t. ML::rlA13.c Llq~lid, SO~S!~:t 1 ."iD=-S\!dim.::al, SJ~'.::.S(u:Jg...:, SS... Satu.t W'-"<(4.l 1 O.o-011, ftaF1ll<<-, r=\Vlii~, U 91 Utim:~ F**fc..:<it, :'ll""l !'ES NO l.) S**IPI< Anolyib R<4<1oilO*I' /\r.ol11icol m<ll1o<l requ*;i<il (l.o. 81'0D, 601GDn47GA) *'Id 1tumbrr cr onnl*ir.ots provld"I for ...h (i.e. 8;6Q8 | ||
* Scdi1m1 Titf.O.St:lflllc, t\ 1u!.CM | * 3, 60/U!JllOOA - I). C1wh>r T<Jmp: | ||
* te:avc flcld c YF.l,l,OW = JllLli: PINK= CLIENT | 6.) Jl1~~trv11it[ve l'~pc: U/\ | ||
* Yos I No Circle C of A I QCSummary I Level [ | * Uy1f ['lttl1lwiic: A.~M, Nt""' N'i1ric Add, SH .. Sodmrn Hy~ll'D)C.fri~. SA ... Sulfu1ic Acid, A,.\ .. A:trnb;i;- Acrd~ HX."" Uex:B:1~1 S.T | ||
* 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;; zgoc Ea stem l'3cilic Ccmral Other | * Scdi1m1 Titf.O.St:lflllc, ~r1:~ prc.5t!\'R!iv~ t\ 1u!.CM | ||
* T:ri() Rtnr.k,, FD .. F:ll'"' r:.q'\llPl'll(l1ll SJ:mk, 'lSO Spike SiJu;p:e, G u.(?rah, C = ) l fu:ld F*ltcrcd: h;')tml mnJr1ccs., w11b Q-v -(tlor)'H. lhc ur11ple ''rAi. f1ogld fillcred or-i"'<i WD:S !lC'l Ct1stvdySMI intact' l DWvOrlnlm;g W::atcr, G\V,..Orn1mJw01ccr, S\Vz-SJJ(.:1[:11 W;atcr, \\.'\\''!::i\V:isJi.: | * te:avc flcld b~1.ni: c WHITE~ LABO RA TORY YF.l,l,OW = JllLli: PINK= CLIENT J | ||
* | |||
* | ccf' 1 Page:---*--*- of **---* OEL Loborotories, LLC Project II: | ||
GEL Chain of Custody and Analytical Request 2040 Savage Road | |||
* v.2.. units:µ</_;. Assay Date: Li.2d10 Response Acceptance Range (+/-20%); uRem/hr +20% | *"Sec www.gcl.com for GEL's Sample Acceptance SOP** Ch~rleston, SC 29407 GEL Quolc II: _ ..... * - - - - - - * ***-* ., | ||
}} | COC Nmnbcr l'l: Phone: (S43) 556-8171 GEL Work Order Number: | ||
PO Number. Falt: 11!4~) 766.11 ?S Client Name: Phone#: Sample Analysis Requested (51 (Fill in the number or conlainctll for ench test) | |||
Shot1h1 Project/Site Name: Fux II: this < .. Preservative Type: (6) san1pl~ bo Address: <Omldortil Comm cuts Collected by: Send Rcsulls To: Note: extra sample is | |||
*r1rn~ required for sample | |||
*D~.\i:: C1.:ltcdc:d f'c:hl Si.\mpfo TSC C(.J!lt.'t!tcd QC Sample ID | |||
.. Far c.-011mo.ri1l!S ~ irrd1c:ufR .sturl wrd .'fffJJJ dutelltlllc (mm-tld*J')') | |||
t~fil!f.ryJ (hbmm) | |||
C0<!0*2' r.~:1acd tn Mut1i1 Aadl A Dad) Rri;u . | |||
Jait1I Jero specific QC | |||
/ \.1 .Gl !D -Z.7..{ I') | |||
' I _I.CJ. 10 2.r.. ts | |||
/'{) i.z. r<) | |||
./ ) 'l .l-3 | |||
./ !.~ .c ( Ill '2."Llf) | |||
/ I . 'J. (;. :2 /0 2,.'2.1 I'{ | |||
cl I ?..C..3 !C z.2..'1r I .1 . ~-:;- IC 7;2. r'S e.s | |||
__ \ ..... n r | |||
- ..... , ...,. ,, - ,,.. (.. | |||
- II'._,,,,, | |||
L, ti TA 1' Rcqucsrcd: Ncnn~ l: Rush: Specify: (S*bJ<<l IU Surchorg') ) Fax Rcsulls: | |||
* Yos I 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 Mounrojn Other Cl1ai11 of Cuslody Sign :itorcs SAmp!e Sl1ippfng and Deliv~ry Dct:\il~ | |||
!tolmqllishcd. By {Sign~tl) Onie Time Received by (~ign*d) Ou!o 'rune GEL PM: | |||
I l Molhod ofShi~nionl: Date: Sliirmed: | |||
2 2 A11bill/I: | |||
3 3 Aitbill#: | |||
l .) DtilJlt or CLos!o.dy Nu!nbcr - CHonl Di.?1£m1incd Fm* Lab Re~eiving Us** 011/)' | |||
l.) QC' Codz:\: N | |||
* N'om~ill S'amp~c.10-= T:ri() Rtnr.k,, FD .. Ft~1d t'~tp11c::iilc, F:ll'"' r:.q'\llPl'll(l1ll SJ:mk, ~rs=- M~Hhc Spi~ci ~iiltr.pla. 'lSO ~ l.'h11d~ Spike Ot:.pl1ca~c SiJu;p:e, G u.(?rah, C =ecin.,~UI! | |||
) l fu:ld F*ltcrcd: F~r h;')tml mnJr1ccs., ir.dm~.!t w11b Q- v - (tlor)'H. lhc ur11ple ''rAi. f1ogld fillcred or-i"'<i ~ rot$;;}\~P*~ WD:S !lC'l l~el\'! m1~rcd. Ct1stvdySMI intact' | |||
*~ l ~*1.stu'.111: Cmh-1>~ DWvOrlnlm;g W::atcr, G\V,..Orn1mJw01ccr, S\Vz-SJJ(.:1[:11 W;atcr, \\.'\\''!::i\V:isJi.: W"~<='[', \\,.,*W.illc.tr, ML.* Mt~ L11'J111d, SO..,Sod, SJ>:~s~uu~icr.t, .SL**.!l~::J,g:", SS*~S:ultd W.as!~. O*'Oil, j:*.-J*'11t~t. l*:~Wi;i1:, {I 'l:nn.::, f"=l7 ct:<i!, :"l**~ YES NO S) Samph: /\rJDJy1i$ Re.q.acS!cJ l\lllllylit~l me1t.od rt'C\ll;;~1td ti~. 8.Z60D. 60JQD/7470AJ C111d 11m11t:c:r llf ~D~11~r!I p10\'1<ltt'l (c.r co,,;~ Ci.i: .*~261111 | |||
* 3, ~OJOB1747rtA - l) Crw/t!r T~mµ: | |||
U.} l1rC:i=.tJ\1'1hVc Ty11e: HA~ Hrd~bl\Uit: Ar:i<t, Nl =- N1!n< f\cjU, SH .. Sodium Hy(.rn:r.1d<:, S.t\""' S~lfl:n~ AcLd, AA .. A:m~rtlJt' Ac1~ 1 HX = Uc)l:i;pc, ST-r .S,:,d11:111 TJm:stolf:tt<!, Er110 r.rc!Cl'Y1.li.,,*.: i11. :uh!.;d"' k.-i,*e; f:~(d hl.i:ik c WHITE~ LABO RATOR.\' YELi.OW = F'ILE PINK~CUENT | |||
App E-Area 1- Instrument Field Sheets | |||
Rev 1 10/18/1~ | |||
Instrument Field Response Check Log 1 | |||
: 1. Instrument lnformatlon Ratemeter: Make/Model: k_c;f/._,~ ?-,;I<.:/ I- z. Serial No. 2(...1..~ Lf I Cal. Due Date: I ;/o 3/t:i..,, | |||
Detector 1: Make/Model: [.1H /cJ11<. 1-f'-(. 11/ . Serial No. Pie ;) fJ °6 '-I 2-9 Bicron MlcroRem Meter: Serial No. i'./ e7 Cal. Due Date: a;, /l~/o - | |||
: 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,.,. . Location | |||
== Description:== | |||
.O~vi-'/" tPy C.~-;- | |||
If:JU 1 7 ~ 1 GPS Coordinates (when requfred): X-Coord: '7~ 7-~ I c.-., ~ Y-Coord: &?f3v 4'1 at:..v l Instrument Field Response 2 | |||
Use Acceptance Criteria Remarks I 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 NA 7.D NA Y.f@~O y '( y J/ | |||
Bicron Bicron Sieren NA NA | |||
'7- 0 NA NA | |||
~/<"9.,D y v ./ | |||
Ot;-.' | |||
IJJ~DO *~ | |||
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 | |||
~ns | |||
~W T~K... ~~VJCE'lli' Rev 110/18/15 Instrument Field Response Check Log 1 | |||
: 1. Instrument lnformation Ratemeter: Make/Model: L. vOl..-vll-'\ 21- YI~ Z Serial No. 2(o2 l '.$1 Cal. Due Date: 0{ 2. i1 t,. | |||
Detectorl: Make/Model: l vji:,.,;,111... t.; 1l*t<-.., Serial No. ff- Ji 11 ;?. I Bicron MicroRem Meter: Serial No. A J. ;:!. '1 IA. Cal. Due Date: I?/'1/il~ | |||
: 2. Check Source Information: | |||
Source 1Isotope:1). 1.. 5 ~ Serial No.: JI(.,,, Activity: ~ units:~ Assay Date:~-, o Response Acceptance Range (+/-20%): uRem/hr+20%__ uRem/hr-20% _ _ net cpm + 20% 219 lb..* net cpm *20% J5' 2 fr''-/ | |||
Source21sotope: Ls /°3>/ Seria1No.:,f7[;'Jj~ .. 'f$" 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 Date: 10f n!i) Time: uJ'Y*{ | |||
: 4. Site or Location: Site/Job:.--'A_,_*_,,,_R..::.<:'.l-1-'-'-..1.I_ _ _ _ _ _ __ Location Descripti on:__.t!/.=......'t..,*5'""f~f... | |||
7 | |||
""" 1"'""0_!1'--------- | |||
GPS Coordinates (when required): X-Coord: N !.(2 ° ,;i ") 1 ( /. \" Y-Coord: l..,J Cl")[" 7'1 '"(< , <" | |||
I I I Instrument Field Response 2 | |||
Use Acceptance Criteria Remarks I Meter Bkg Bkg Counts Source Source Response +/-20% Inst. Battery Time Ambient Initials and Comments I | |||
Cnt Time (cpm) or uRem/hr) | |||
Cnt Time (gross cpm or uRem/hr) source gross cpm Calib. | |||
current Check | |||
{Y/N) | |||
Of check Temp. | |||
(oF} | |||
{add'! Info: inst. Condition, etc.) | |||
oruRem/hr (Y/N) | |||
(Y/N) | |||
Ratemeter I m}IJ f! Ifs- Jm11J I 1M'J. y 7' y Dl't'i . l(/. "! 'fl.. Z H. l Ratemeter / mrr./ Vt/<( J 1111,...I fl t;t.< y y ~i O\**rt \./ 'fl.'] . ( ( /J) i R.atemeter ),.n1tJ 7(..l £, J ll'll*V /90J'f' '/ y y l'tl< (?.I fl,?. n I I | |||
Ratemeter I | |||
r m11v IG!.>-b .I v1:"-' J1o;v '1 t y J'{(!/ '{q I t~ 1n I | |||
' 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~' | |||
I Bicron NA < NA JI v ,y y D£*1i,-' 'if' .(1 ! | |||
Bicron NA t~ NA IR '-i y I /'it*:/' {'I. 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}} |
Latest revision as of 18:05, 24 February 2020
Text
App E-Area 1 - COC Forms
~p\0\ ~f>rYA/ t P a g o ; - - - - - - of Project II:
GEL Chain of Custody and Analytical Request GEL L.sbo!'lllaries, L.L<:
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)
Should Project/Site Name: Fax#: this <-- Preservative Tyj)C (6) sampl~ bo Address: con1ldered I
Comments Collected by: Send Results To: Note: extra sample is
'Tm1c required for sample ,
- D1u0: CnUecl~il C"a1:\~1,'l.f, QC Fiol~ Sump!" rsc specific QC MotriA Rodi f-1!rc-ml I; Sample ID (1Plll*d~*)1')
(Mllll*ry) Code*> ('j OAC:U lt*gu
" For <:v11111oslle.\' ... J11dic:alf' :Jtan a11ti s/u1> 4otelthne !lihn1m) J:1ttfl ber <1 I. 3. C.. I l~-'Z,H~ Of*.?jO N 1,3,c..,Z. 10--t,H S- '1:50 ('.l
/, '3' (...., '3 1u--i,\-'\$ )0'*00 N i 3. (...,6 I 10-1.l-f~ Cf:"-/o Fi>
Ii 3, c. {d ru~'1\-1~ Cf '-$15" i;:,D
- 3 I\ t../, k,, I 1n-1Hs (Q'.q:;; t1 3 I \ o L{if!. l f r6 '""'1..1--1<; 11._c£ ~
~.l,l-/if?-*3 IO-L.1--t'< 11*.~,i:; tt.l .*
3, /, Lf ,e,1-f lb-&H< W;1-.0 N TAT R~aucslcd: NormQl' Rush: Succifii: {Sub.it*t1 '" s.... b~'E*} I!'ax Rcsul1s: Yez I No Cirelc Dcliv..:rable: C of A I QC Su1t1marv I Lm1cl l I Level 2 I Level J I Level 4 Re11111rks: Are there any known hazards applicable to these .vamp/es? l{.ro, please list lhB hazardr Swnpl!) :CQll~~lion Iim~ Z1:ml.l Eastem Pocific Ccntr&l Other _ _ _
M0tmtnin Clialn of Custody Slguiiturea Sample Shipping ~nd Delivery Derails ltc[;11q11ishttl l.ly {SigncJ) Dnlc l'lmo RoociYcd by ($igned) Dore Time GEL PM:
I 1 McJl1ud of Sh[omcnt: Dale Shinced:
2 2 Airbi!lll:
) 3 Alrbill #:
q 'Ch11llt ofCu~c.iy Numbizr;.., Clittil De.u::rmlncd F/Jr Lah l!~~riM11g Us~ 011/y l.) QC.- t'cd~o: N
- Non111d Samplo, TD* Trip ill*n~. FO
- l'iold Duplk*la, Ell* llquipmtn\ nl*ll~, MS
- M*rri< Spiko.Semplo, MSD
- M~:ti* Splko Durl<<olo S.mplo, G
- 011>b, C
- C~mp,~ito
- 3) f'tld f1lmtd: For (iquld m~1rlw1i, lnd!c.DJc: wiU1:i .. V.foryIJi111~ s11mpt:: wc.s. fic.td rd,~rtd or .. H .. ror sornpJc: wa1 riot Hotd rmetvd. Crr.ttody Set1! Jntaa?
4.l M::a!ri~ CCldi:~ DW=Drfa'Ming W;tlcr, GW*Grou111.h...,t1k!r, S\V=SurCecu \Vorcr, \Y\Y-aW"$h: \Vlliti:fJ Wi::\Vo111~t. ML::rlA13.c Llq~lid, SO~S!~:t 1 ."iD=-S\!dim.::al, SJ~'.::.S(u:Jg...:, SS... Satu.t W'-"<(4.l 1 O.o-011, ftaF1ll<<-, r=\Vlii~, U 91 Utim:~ F**fc..:<it, :'ll""l !'ES NO l.) S**IPI< Anolyib R<4<1oilO*I' /\r.ol11icol m<ll1o<l requ*;i<il (l.o. 81'0D, 601GDn47GA) *'Id 1tumbrr cr onnl*ir.ots provld"I for ...h (i.e. 8;6Q8
- 3, 60/U!JllOOA - I). C1wh>r T<Jmp:
6.) Jl1~~trv11it[ve l'~pc: U/\
- Uy1f ['lttl1lwiic: A.~M, Nt""' N'i1ric Add, SH .. Sodmrn Hy~ll'D)C.fri~. SA ... Sulfu1ic Acid, A,.\ .. A:trnb;i;- Acrd~ HX."" Uex:B:1~1 S.T
- Scdi1m1 Titf.O.St:lflllc, ~r1:~ prc.5t!\'R!iv~ t\ 1u!.CM
- te:avc flcld b~1.ni: c WHITE~ LABO RA TORY YF.l,l,OW = JllLli: PINK= CLIENT J
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GEL Chain of Custody and Analytical Request 2040 Savage Road
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COC Nmnbcr l'l: Phone: (S43) 556-8171 GEL Work Order Number:
PO Number. Falt: 11!4~) 766.11 ?S Client Name: Phone#: Sample Analysis Requested (51 (Fill in the number or conlainctll for ench test)
Shot1h1 Project/Site Name: Fux II: this < .. Preservative Type: (6) san1pl~ bo Address: <Omldortil Comm cuts Collected by: Send Rcsulls To: Note: extra sample is
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App E-Area 1- Instrument Field Sheets
Rev 1 10/18/1~
Instrument Field Response Check Log 1
- 1. Instrument lnformatlon Ratemeter: Make/Model: k_c;f/._,~ ?-,;I<.:/ I- z. Serial No. 2(...1..~ Lf I Cal. Due Date: I ;/o 3/t:i..,,
Detector 1: Make/Model: [.1H /cJ11<. 1-f'-(. 11/ . Serial No. Pie ;) fJ °6 '-I 2-9 Bicron MlcroRem Meter: Serial No. i'./ e7 Cal. Due Date: a;, /l~/o -
- 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,.,. . Location
Description:
.O~vi-'/" tPy C.~-;-
If:JU 1 7 ~ 1 GPS Coordinates (when requfred): X-Coord: '7~ 7-~ I c.-., ~ Y-Coord: &?f3v 4'1 at:..v l Instrument Field Response 2
Use Acceptance Criteria Remarks I 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 NA 7.D NA Y.f@~O y '( y J/
Bicron Bicron Sieren NA NA
'7- 0 NA NA
~/<"9.,D y v ./
Ot;-.'
IJJ~DO *~
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
~ns
~W T~K... ~~VJCE'lli' Rev 110/18/15 Instrument Field Response Check Log 1
- 1. Instrument lnformation Ratemeter: Make/Model: L. vOl..-vll-'\ 21- YI~ Z Serial No. 2(o2 l '.$1 Cal. Due Date: 0{ 2. i1 t,.
Detectorl: Make/Model: l vji:,.,;,111... t.; 1l*t<-.., Serial No. ff- Ji 11 ;?. I Bicron MicroRem Meter: Serial No. A J. ;:!. '1 IA. Cal. Due Date: I?/'1/il~
- 2. Check Source Information:
Source 1Isotope:1). 1.. 5 ~ Serial No.: JI(.,,, Activity: ~ units:~ Assay Date:~-, o Response Acceptance Range (+/-20%): uRem/hr+20%__ uRem/hr-20% _ _ net cpm + 20% 219 lb..* net cpm *20% J5' 2 fr-/
Source21sotope: Ls /°3>/ Seria1No.:,f7[;'Jj~ .. 'f$" 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 Date: 10f n!i) Time: uJ'Y*{
- 4. Site or Location: Site/Job:.--'A_,_*_,,,_R..::.<:'.l-1-'-'-..1.I_ _ _ _ _ _ __ Location Descripti on:__.t!/.=......'t..,*5'""f~f...
7
""" 1"'""0_!1'---------
GPS Coordinates (when required): X-Coord: N !.(2 ° ,;i ") 1 ( /. \" Y-Coord: l..,J Cl")[" 7'1 '"(< , <"
I I I Instrument Field Response 2
Use Acceptance Criteria Remarks I Meter Bkg Bkg Counts Source Source Response +/-20% Inst. Battery Time Ambient Initials and Comments I
Cnt Time (cpm) or uRem/hr)
Cnt Time (gross cpm or uRem/hr) source gross cpm Calib.
current Check
{Y/N)
Of check Temp.
(oF}
{add'! Info: inst. Condition, etc.)
oruRem/hr (Y/N)
(Y/N)
Ratemeter I m}IJ f! Ifs- Jm11J I 1M'J. y 7' y Dl't'i . l(/. "! 'fl.. Z H. l Ratemeter / mrr./ Vt/<( J 1111,...I fl t;t.< y y ~i O\**rt \./ 'fl.'] . ( ( /J) i R.atemeter ),.n1tJ 7(..l £, J ll'll*V /90J'f' '/ y y l'tl< (?.I fl,?. n I I
Ratemeter I
r m11v IG!.>-b .I v1:"-' J1o;v '1 t y J'{(!/ '{q I t~ 1n I
' 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~'
I Bicron NA < NA JI v ,y y D£*1i,-' 'if' .(1 !
Bicron NA t~ NA IR '-i y I /'it*:/' {'I. 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