Embed Size (px)
Citation preview
------------------- ---
App E
Sub-Area 3.2 - COC Forms
Salnplel!) . •Fort·-tJirum:fitr,'f~M Jmlif!1.itt!· . .;1ana11d :rf<ifl Jiite/time:.
·Dale.
'l.
---------------;:------------------------------------------------------
, ·~r»r~·~~~llci..1~"11
(mm,dd-n)'
i
Tii,;s
•;,
Commcnis Nrifi:: .e:(tra sample is. tequiredfor sa1npfo
·specific. Q~
No. •,CirclcDclivcrabfo: C of A l :.QCSuml11llrv I LcvcU 1 ;tcvcl 2 I 'tcvcD I 'Level 4 · · Sainiile Colfoc1iorr'!'ime Zone
Elisiefn · Pacific · · C61tr~r Other ·
, : ,Mou~rain
. GE.t;'PM;
DafoShimml:
Airbill·#:
: Alrbillt1: t.) .. Ctii>ln o{Cl!;;.tOOy,Nu1rib~-'":':l<litfti--DCiirnliti~d· -
- - -- . . · · . . . - -,. . . . . . · , . . frlr L~ap,.Ri2i.:eivjq1{_.~.-:srO~!~· : l;F ()f..C'fd<•:·N:. ~ !>fomla!S>J!ipl~,."'.!J;-5J:rin1Jl~~~,:Fll."' f;<ld.lffl1li<ii10,KB "'. l'.4.•ip"'9it lll'?1•: ·~JS, M;.1(i.<Spik~S~m)llc).;'llSJ?"'M•lrx S~il<.~'Ot'!lli<iil• Si\rn11lc, <t~ ffi;"b~.I:" s:~"'ll!>'"" ),) F[~id Eil1orod:'. For ~quid mH[flc~•; in~i.,.,1c wi* !1 ·Y-Jor y<>1ksamplc.~.ni lk]d·lll1cml·.or-· N -Jo( Mll)plc wo.•·qo1·fi~Jd 'fiiiorc~: , Ci1stildir$~al fnft1''1i0
·~ti M"~r~x CndCs:·DW~i,OJinkio_g·-w~11.;;:G~\':.:Qr~1~~w-a1.,;r .. :.~\.\~,..:.SiJ1f~ti~w11t~r~ ."'W~W~~t<! 'W~1\:r:;~\\'.~W.a~~~ ... ~i_t:yJf\1i~ li~lui.~, -~~'-~Sitff~'S.0~.~~.~-iri!~ut,.·st.~~~ lu~g~~'.~-.tSd.Ji.d_·W~1c,:.<'"''Oli~~lt~~iifcr.:P""'-Wi~ u~1}rir.i.:r P"'t:~~af~_N""~,_ ___ }!_E_S_: • ___ .,...f'W_·o_· ·-----<
5.)·~iflp. !~i\n•iy,\3~~qu<...i<J: !\n~fyJicpl mclho.d rciju<A<il (i.<. Jfz.6~lh~~1~!1i1~7u~j ~~a. noiilb•~o.f<(•nt~ir!"!•.P!O,'lil~~ m~.~~h <i~;N~~ .. o.B,~j;}o1paizp~:,,- i1.: .· . ' '· . . · · · .. · '· · · '· Ciwlitr.;Temp: <•;), i>l•mvoff,:.;:rYJ;.;1i,~ ,, Hwr~c.blurio;A£lil,·l'.il ,, Ni1ri~· A<!d, SH >eS~ili~m.liydroilW..C-sA ·~ Sulfun~A<td: A;' .• i\mnbic A~~;:ux ·'~J~"1iic. ·s-r~-.saji~11t'l'b!<li.•lf•lc, t(n~Jl!<S<f'l3li•·o;. i•:•ddc<1,. .1iav< 1lc1d. blank · .. · ·c
wHp:E= J~A:~OJ{~Vl'ORY, v~j;c.qw"" 11'1.t:'E · m~1~.c=~1;~m'rr: ./
~;
~age: ____ . _____ qf~ _______ _..,1
Projlietll:
QELQuote ti; --~--~~---~--CCC.Number <1>:._
PO'Nu111ber!
GEL ChuinofCustody and Analytical,Request ~*Seeww~v.gd.com:Tor.GEI:.'s ·sample Acc~ptance SOP"'*
QEC L;iboratories, LLC 1 ()
· 2040.Savago Road
Chaf!e:;ton; sc:29407
P!t'qnu!-(843) 556~.s rn fax: 18431766~1178
Glient-Namc: '.Phone#:' Sam11le-An11lysls ·Req11este<fJ5I, (:f'ill itl-ilie number of contalners·Jor.eacl< iest)
Projl'.cl/Site N~mc: Fax#: Should·;
1w>" 1--------------~----~-----------------------1_$_~111pl~b~·
A,d<;lrcss:
ScndJlcsulis To:
Sample ·m ·• Fo,. comnosile,r .. itrdico/t' start om/ s/Of) Ja1eJiime
'*Time. C:oll«!'J
.{i.UU1~ry) ,lh~lllDI)
.cunsloo~d
<-- Prcscrva_livc Type (6)
.commen~
Note: extrasamplds i-eqi1fred for sample.
speci!ic' QC
'TAT.Rcqucslcd: Normal: Rush: Succifv: (Su1li«t '" Suwharg<J''l l'a:1. Rrn1l1s; Yes .Circle Odivcrabic;: Cof 1\ l OC Summarv I Level l /' Level 2 I L<:v<:f.3. I Level 4·
Re111a1-ks: A r<1: there.apy ~rJown.hazardr appli¢ahfe to these samples?)[ so; plea.1·e /if;t the. hazard~ · Smnr)le Ci:>llpgion Time Zom Easiem ·Pacific C~u;ral Other Mountain'
·sa1µple Shipping aml Delivei:y mitalls
. GEL.PM: .Dote ·Dino Relil1•11iishcil.1ly (Signed)
'l Mctbod of SliinmCJll: 1 Date'Shioncd:
,2 Airbtll#:
3 . Airbill#: : I,)' tlramoCCu•tody N_un1b~--~ CliC11I Oot<'nnii:~ ·
· . . . . . .FQr J,.d_lfReco_'ivi11g Use 0111)'_· 2:);Q<'.Codc<: N "No<n••lSaniplc1;Tn •Trip Blank; FD-.g !ilolifD"!'!koto; Ell= f.q•ir11•01Wlll.,ik; · :\tli- Moi<i• Spi~_1iSamplo,MSD ~.M.u1~ ~pi1<c:n11plioatc Samplo,.Cl ~ Gii>b, C ... :con1;io~iio .. }} l'iolil: F_llm<d: for liquid rif~1fi~·indko1c '~'" • -·V •'for;y~· thc,•01llpk iVllll field m1mil or».!"• f~r '"'"Pk was no\ f~W fl!t<.-od, .Custody Sea/1ntae1? 4,l·Mu~;x'cod~: D\V~D1iJiking_ 11i,jc;;:GW=Giuuu<lwo!<f,SW=Suif~co;\Varor, ~VW=W~_~'.\Y:i1ir;W=~o1q,.ML~Mi»: Ll~nid, SO~Soil, Sll·'S•'<!im<ol,SLmSludsc; SS"S.<•)id'Wli>lc; o~pil; )'•filtcr,'P«\Yip<,_U~u,;rn:; F~!'"PI, ~7! .. ~ --~rE~'S,_,_ _____ l'l_'0 __ --1
.• 5.)•Samplt t\naly1is Rcqne>!td; /\n>lylicol.m••b•~· r•QUCSl<d(i,o. s:~oli,~lll0Jl/747oAi:.,Jd nunlb<r.of C<•Ol•inc" pr~.;id<J .r'o~ ...;h (i.<ili2~0B --3, 60W!Jfl471JA-- I). • . . - " C1•oler Temp: -• oG.) .rre~<tv~liv_c_ Type: UA ~ llydwoblori< /\Cid, NI ~·Nilric-A<ill;Sll -Sodi•in Hydroxidt, SA.= Sulfuric A<id.'M • A«:o<bkAcld. HX = He.,n<:. S'l'·•Sodinm Thio•ull<>1t, Jr ~o_pY<,.1v,Mivc i• added~ lc;wo lltklbl•nk · . (;' j . , . .. . WllllE •LABORATORY . YEI.J&!W ·•FIL• •PINK• CW!l'°'
r '
-Coy~~ ·.:-"· . . . A . ,.... .. ~ .. --·------------~-----------------~-------.------------------·-
;Pa~c:_._ir: __ ._ .-... vf·_· -· fL' ·'~'"--{ · GEL Chain of Custody and Analytical Request l'!OJCCt#. NI A,, ·. i . . . ' . ,
G~L_ ... 'Q~otetl: -.. ~-·Pt, _. . . •. ·t'· . · .. "Sccwww.gcl.com for-GEL's·SamplcAcccptancc.SOP"·'"
OllL Laboratories. LL{'.
2{)<1Q S~yagc Roud
COC.N\11nbcr 1'': !";~ P~T 'GRL-Wor.k Order .Number·: PO Number: 1\1 t A · . ..
'
: cimr1es1on, sc:29407 Phone: (84'.l) 556-8171 Fali:J843l 76.6-l l7li
Client ~ame: Phone#: Sample Analysis Requested !Sl (Fiirin the .number of containers ibr ench test)
Shouhl 1· Projec1/Si1c Name: 11111 1--------------------------'---"'--~----------------I ~am11l~ be'.;
·. Address: i'!11)ld<~<<l· ·
Collected by: Send ·Results ·To:
.Sample ID ~:ftm: comn"sitr.r.,. imlu:atr ,J/1Jr/,mul ~ffm <lut~llimr:
11Tnne _C'"lki;;tcrl (Millt.,y)
H1ht11rrt)
QC.·tl?tl~-'"
.'JS(> Rodi A
·,o..idl R"'g~ ,
f!".hl ;S:·•·r.p)ll·.' F1i?~red MJlriJ.,.
iJ;' , (It
· •~ l•tr<I JC.i'O
5. 2_, 7; fl.. .. 1 10.~1r~t~ 16:.rI'N· NIA NllA vVJ' N 1 z. z, 1+. e.. z. tv1cr-rr to:ro · ~(j. NIA. }~/i',,, 'N 'l\J .1
~ l ; 4· . f2 - s b· i 9-"'1~' 1'1~ 10 ' ri>- i;J/ A: N /AN 1\J r
<--. .l'rcscrvatiw Type (<1)
Comment~.
Note: cxtr;i sample is -required for sample
spec.ific QC'
3,1_7 R, l N~~~~ ~-:~~6+1-~~---*-~+JA~-+~N~.1~-~+··~N+··-~~~i~--~~i~-~~~~~~~~~~~~~~ 3. \ . 7 ' (2. 2- 110'/S;~{ ')" IS: DD \1<,) '(\if/A \'\if fl· M rJ .... )( :S:'t ./, 0 rz.
' \
~~·''- g, e' z rO-t'f~l~ Gt:;;; )\i N/A NIN µ :f)). L 3' .-1 . 15. K , 0 1 o- iq- is. 14~, 1s· ~e ; N./p.. }\)h\ .10 rJ l
b-'-'=-_;._~~~-'-.--~~~~~~~~.....,..~~--''--_;...:;.__,
-TAJ Requested: Norina!: ·Rush: ·S!lccify: (~cbiccnvSwd»ti:•; lrax'Rcsults:. ·Yes . No.· Cirde-Dcl!vcrublc: :c~ofi\ I QC.S~mmaf\' Level I i Level''.! l l.c\'cl 3 I Level 4
Remm·ks: Are /here.· (J11y.k1io.w1i-hawrd,v applfr.;c1bf e.io :11ie.wsa111pi es? f/.1'(J, plet1s<1 /i~·f'fhe.hazarrfs .S.i•lllplo Collccligu Tirr:c Zon~ · !!astem Pacific :Ccnu al· Other l\founn1ii1.
:Clmi11 :pf_(:J!stody.Signnt~rt:~ '.Sl\mpkSblppjng,a!1d Deliv~ry Dctnils· lklii~111i~h•tl !lY (Sig11cJ}. · 'Dale· Rmi-.icJ.by (~1_gncd)°
·r;k1hudcf-Sliinmont: Date Shinu~d:
2
Airbif!k:
,,.t.~<1r L:a/J,,Rt!,''1iving. llse.Q1i!r i .. ;-· QC Coc!~'~:·x· ... ·xo:iu:d ~amr!C •. TH ... Tri1>.0lan1t:. ffl;,,;,, "J~!d Ot1pJk;..1c,·En·"" RquipT)1cnL.Bbl1k. ;\J$ t::' Maui:t: Spf~C.Sa:;"11ple,·:\1S~)- Mr:11ix 5pi~o. Dt1r.lt.otc S\'1~r1e, G .~ {i~.3b/-C •.C\'mpu,illl!
i) ::yi~td;Pi!l.cr~di fpt liquid .r.1airice~~ inditntc w1t_l101- "/.a.for y~Jhlr~~in;:~. ~~l!--.,·.fi~ldi;it~r~d o~ ... ':'; .. 'r1;r J.<liUp!~ ·\~~£.not,Jkld r~~cted C11:umly Seal ln!iJct'I· :.1~1· Matfi"(<("ciJcs: ·D'V"'Dsi11kinu W:i.t:i,; G\\'~Cihi1JotiW.th.•1, 5\V:.~suifat,_; \\'afc1, '''W.-·Wlli.ti;;i\V.1!<-r; \\'~.-w~1':r. ML~·~fo."·Li•ru~I • .59·~S1.1I, 50 ·\~~tlfoi:.:~:t;·SV."Sltl!i;-.:, f):-; .• ,s,,Jut \\' ..... ti;'.-~·>'}.Ot!A V=·flhc1; r..-WfJh:. tJ,..,l:t1n~,·f ~:rc~a1. ~'"!1:----=l-='l!.;:;''S=-:,..--:--'-N"'O ___ -j
.$;)~~;1mp!t'J\1iA1y:fi.s"R~qm:~ti;"d" · Antl~l!1:al '~tlhotl'rcqutHt1.l,(: .. e~ 82~0D, 60Ji>l117471JA1 nnJ:,wnb('f\•f\·o:l~n~ncn.JHO"~t·fort:<i.i;h (1:~·. :1:2.'.0JJ ··3;60flJBiN10A ';,,.}). 'C,11c1/c:r Te!np; (i.J· l!i~t~1v~ir~c Tyric;.~JA·~ fi>:dr-13.Cf~!oii~ A~i~. NJ.-Nih_IC AcJ~.'Sll"' SatlJ~uu I !>'dn1~id~; .8;f~ .Sulftriji;. Aca1I, ~~,~ ~ A~c<:iibJi ~.:id,. HX ·;;.:1 {1?\~;10~ ~:r ~·~foJ~,m~ Tllio1i~?fo:!?, :ff 110 PfC~JY11f!Ve: i:\ ai!rl~d .. l~:i\"<: f:cJ:~ b~omi-; C
. . wmrrk:;,.l,t\BO!l.i\T()R\'. . YRLLOW,,. mu: . P.JNK'c,CJ;II<;i\'T· .
App E-
Sub-Area 3.2 - Instrument Field Sheets
Rev 110/18/15
I I
I i
l. Instrument tnformation1
Ratemeter: Make/Model: Detector l: Make/Model: Bicron MicroRem Meter:
Instrument Field Response Check Log
'-..
Serial No. rl()6~'lf Serial No. /?,etJ;1£}1.2. . Serial No.-----
Cal. Due Date: -
Cal. Due Date: __ _
2.. Check Source Information: -Source 1 Isotope: 76-232. Serial No.: I [ { Activity:<:O. I units:,vl'.:: Response Acceptance Range {+/-20%): uRem/hr +20% ___ uRem/hr -20% f'L-
Assay Date:IQ/'§/l'o net cpm + 20 " S:i ~9' net cpm -20% 3r¥6.t:
Source 2 Isotope: LJ",/57 Serial No.; l(Cf£;3 ..-( 2- Activitv: 0-02 units;.vu· Assay Date: _&&_ Response Acceptance Range {+/-20%): uRem/hr +20% ___ uRem/hr -20% __ net cpm + 20% /$.:Z7s net cpm -20% B f't'1'
3. Checks: Title: - fZC{ Date: !O/l-;--/15 Time: /Do.)"
' i
4. Site or Location: Site/Job: Ar~,.,. .'J. ?- Location Description:--' ___ £-',,,'"""":....""°' __ -_____ _
GPS Coordinates (when required): X-Coord: rJ A V-Coord:~_--<.;1/_.___,A-__ ~-
! Instrument Field Response 2 Use Acceptance Criteria Remarks
Meter Bl<g Bkg Counts Source Source Response +/-20% Inst. Battery Time Ambient Initials and Comments
Cnt (cpm) or Cnt (gross cpm or source Ca lib. Check Of Temp. (add'! Info: inst. Condition, etc.) Time uRem/hr) Time uRem/hr) gross cpm current (Y/Nl check (oF)
or uRem/hr {Y/N)
(Y/N)
Ratemeter I Mil\. ql{3 / t"l:W I Juin l/'{i.~.1 C/JIV'. y v v !Olfs 5"~7 fh-~32 J}y i Ratemeter t All;v... /O'l1L ,;,,.,. YI v ...:/ //)~ 5"-'-~ cs-/!.7 VtJC
Rate meter I I I I (/-
Ratemeter Bicron NA NA Bicron NA NA Bicron NA I NA
-
i Bicron NA NA 1, Instrument designated check source Is Usted 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 additional counts to evaluate instrument stabllitY
-------------------------------
--
i
! i I i
l
Instrument Field Response Check Log
1. Instrument lnformatlon1
Ratemeter: Make/Model: ~ICRMJ ~YHC12D 0;7A Serial No. /t)) l/ Ll. Detector 1: Make/Model: '"It1('71:{£iVA L. Serial No. ...v/ri
Cal. Due Date: ~ lo
Detector 2: Make/Model: Serial No. ____ _
2. Check Source Information: source 1lsotope:/hl-1 l.. Serial No.: 11 le Activity:~ units:MkL_ Instrument Response Acceptance Range (source cpm · bkg +/·20%):
:Assay Date: --t:Z/-; .)1 v net cpm + 20% net cpm -20% __ _
Source 2 Isotope: Serial No.: Activity; -~-units: __ Assay Date: __ _ Instrument Response Acceptance Range (source cpm - bkg +/-20%): net cpm + 20% __ _ net cprn -20% __ _
3. Technician/Worker Performing Checks: Date:~ Time: 01.S"J. Name: S~v'e" KtN~t11Ar--.i Title: _____ _
4. Site or Location: Site/Job:_"'"3-'--,-'--=---------- Location Descript ion:__,6'-'-,q'-',e~&'\"-'-----------' I U o I •I GPS Coordinates (when required): X-Coord: N Li. ·z..t ?Y.1 " /j Y·Coord:V)C>·1¥ '::{p' ;n.z.
I_ ... _ ···- -- ___ .._ _ _.,_,,_~·-~-------·-·-... --·-----'----···~ -·--~- ----·--------
Instrument Field Response2 ;I Use Acceptance Criteria ~ Remarks
I Det. BKg Bkg Source Source +I- 20% of
.. Inst. Battery I Time I Ambient ti Initials and Comments .,
j No. Cnt (~) Cnt Response source Net Ca fib. Check , Of I [add' I Info: temperature, Inst. Condition, j T~~P· ~j
. (1/2) Time {.cPfAt Time [q.ta -bk~) cpm current (Y/N) check etc.)
. .IA ill#!l Net efJm {Y/N) (Y/N) ·-· -· -<· .. -·-·-··- .. ··-· ······- -- --·- --.--- ···-· --··· ·-· ··- ···- - ·····-·
LlJ..R/ 't? y v n75:1 !../%. z_ .Sit: --. '
I~ f I
m :
-
' 1. Instrument designated check source is listed on calibration st1c:ker. Record check source response (net cprn) prior to field deployment for all check sources bein{l' used.
2. source and Background count rate should be determined from the average of tliree static counts at the same locatio11. Repeat counts should be within 20%. If count rate diverges slgnlflcantly, perform additional counts to evaluate instrument stability
l i l ! i I
Instrument Field Response Check log
1. Instrument lnformatlon1
Ratemeter: Make/Model; L uOLli;A. J-;lf {.) Detector 1: Make/Model: lvAv/'A 'I L/~t o Detector 2: Make/Model:
2. Check Source Information:
Serlal No. 21./l,, I 31 Serial No. /Jt..U! I~) Serial No. ____ _
Source 1 Isotope: 'fh Z 12- Serial No.: // lp Activity: ~ units: ,.,v- c.i
Cal. Due Date: 3}-2} / lo
Assay Date: Ii{ 1° /1 ° Instrument Response Acceptance Range (source cpm - bkg +/-20%): net cpm + 20% net cpm -20% __ _
Source 2!sotope: Cs lJ7 Serial No.: f'7£1?·-<li' Activity: •. 02 units:~- Assay Date: Mo Instrument Response Acceptance Range (source cpm - bkg +/-20%): net cpm + 20%. __ _ net cpm -20% __ _
3. Technic:lan/Worker Performing Checks: Name: 5'17fV'l£ t:1cJVAW Title:_______ Date:12.}_,~/rS" Time: /DOD
4. Site or Location: Site/Job:_"3=-'-=Z...=---------- Location Descrlptlon: _ _._6q..!...!..~:...=_;;,_ ________ _ GPS Coordinates {when required): X-Coord: _________ Y-Coord : ________ _
· (! +/· 20% of ' Inst. BatWy 1 Time Of
cha ck
Ambient Temp.
(F)
Initials and Comments j !1 source Net Calib. Check j ii cpm , current (V/N) I
j (add'l lnfo: temperature, inst. CondJtion, J
etc.) j l :i (Y/N) (Y/N)
:::::::::::::::::::::::::::::~-~*~~-==-· _·L~-=-·_2
·_":~~v~~~::y-;:::::,~n=~D=O~-=-~~:~~r.~.:L;::::5:·~::::::::::::·:::_:_==-9
·
l----+---·-.. ·-1--------+----+-------i:,J----"""·-"------- --~-~1----+---~ .. -- :- - .. --------------i
1. Instrument de!>ignated check source 1s 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 averafie of three static counts at the same location. Repeat counts should be within 20%. If count
rate diverges stgnificantly, perform additional counts to evaluate instrument stability .
Instrument Field Response Check Log
1. Instrument lnformatJon1 0
Ratemeter: Make/Mode!: \l)\c..fatJ /Y\lC£b e f!}A. Detector 1: Make/Model: feA/-tCWlf l Detector 2: Make/Model:
2. Check Source Information:
Serial No. A '?.-?.-l( lA
Serial No. _____M.A=----Serial No. ____ _
Source 1 Isotope: ·Tf, ()J. "2- Serial No.: I I (p Activity: ~ units:~
Cal. Due Date: r/lf/1~
Assay Date: 12 /s "i>/r o Instrument Response Acceptance Range (source cpm - bkg +/-20%}: net cpm + 20% net cpm -20% __ _
Source 2lsotope: Serial No.: Activity: ___ units: __ Assay Date: __ _ Instrument Response Acceptance Range {source cpm - bkg +/-20%): net cpm + 20% __ _ net cprn -20% __ _
3. Technician/Worker Performlng Checks: Name: r-reve K<rVJf'.yl,tV Title:------
4. Site or Location: Site/Job: __ J_, _'--_________ _ Date: f"il}rc,./1<Time:/L/_Db Location o·escrip1ion:-'h'"'"~:....<..;.;~"'-i,___ ________ _
GPS Coordinates (when required): X-Coord: Y-Coord: ________ _
Source 1 +/- 20% of Response ('"~
Ncl-epm 1\ . . .. -~
source Net cpm (V/Nl
Inst. Ca lib.
;1 current t lY/N)
Battery j Time Check Of (Y/N) l check
--· ·~··-. .. " --~ -..:1 y Jl(OO ·~-+---+---v;<------1----+---.1'-"9_.._,...,.,,,,~.R~IN,..:~---+---'----1---'---+--<--', ·'
Remarks -·
Ambient l'j Initials and Comments Temp.
11,dd'liofoo temperntm•,>o'1. C°"dittoo.
(F) j etc.)
j ,, . - - + ··- ~=
5"1. f.p ' ·~
i I I ! i
f------t----+------+-----1~------lt------j~----+----f----+----4~-----~-------~
1. Instrument designated check source is listed on calibration sticker. Record check source response (net cprnj prlor to field deployment for all check sources being usecl. 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%. Jf count
rate diverges significantly, perform add ltlonal counts to evaluate iostru ment stability
_J
Instrument Field Response Check Log
1. Instrument lnformatlon1
Ratemeter: Make/Model; f.:_llQLu,Vi_ 21!-(f, 2-Detector 1: Make/Model: lv!JL UtVL 1-(1./-t v Detector 2: Make/Model:
2. Check Source Information:
serial No.a k& 131 Serial No. f!llll t 7-. 1 Serial No. ____ _
Source 1 Isotope: TbJ? 2 Serial No.:~-- Activity:~ units:~
Cal. Due Date:~ L.-
Assay Date:~/ o
Instrument Response Acceptance Range (source cpm - bkg +/-20%): net cpm + 20% net cprn -20% __ _
Source 2 lsotope: G:._/1..l_seria! No.:f 1 [ { J- '(.f Activity: - o i. units~i;;t· Assay Date: J}Q}i._c, Instrument Response Acceptance Range (source cpm - bkg +/-20%): net cpm + 20% __ _ net cpm -20% __ _
3. Tedmlcian/Worker Performing Checks; Name: S1J?.!if l<1#Jrr-.1r,,_/ ·
4. Site or location: Slte/Job:_'3_·_. 7-_________ _ Title:------- Date: t<Jh~f1s"' Time:"'""/_,_Y_ro __
' I Location Description:. ____________ ~
GPS Coordinates {when required): X-Coord: _______ _ Y-Coord: ___ _
. <rule~ Instrument Field Response < vP?-S· --!1 __ .. ·-- ---- --·----·------··-·---· --·-------- -·-- ---,i--
C-r-; Use Acceptance Criteria ~ Remarks
~- BKg Bkg Source Source ; +/- 20% of ~ Inst. Battery l Time / Ambient 1[1 Initials and Comments (avg of 3)
I
(udd'l Info: temperature, inst. Condition, No. Cnt Cnt Response source Net
I_
Ca lib. Check Of Temp, · {1/2) Tl me (cpm) Time (~.I cpm current (Y/N} check l (F) etc.)
~Jet er:it'l'r . (Y/N) (Y/N) ....... ·- M--~-1 ......... ._ ..... -- ... - --~-
·(/.,JTt lf'llttV /lv"l I I mq,.; i19J.) y' y I '?Io ~1~ '-" 5t I I~ /~1 / ,,, /Jo/ ·1~ 2.1 I nitfo,/ ii/(,,/ v y I l( l{ C?.0 ' 5~ .
·, '-•
! '
-
1. Instrument designated check source is l1stad 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 locatton. Repeat counts should be wlthln 20%. If count
rate diverges slgntflcantly, perform addltlona! counts to evaluate instrument stability
·-
Instrument Field Response Check Log
1. Instrument lnformatlon 1
Ratemeter: Make/Model: j_ uf) l U.N'-- 'J-? '-ff-· Z.. Detector 1: Make/Model: l uh VA/\.. lfll-1 o Detector 2: Make/Model:
2. Check Source Information:
Serial No. 2<,,, LJ 3 J Serial No.{£. 111/'l 'I Serial No. ____ _
Caf.DueDate: q{z./14'-
Source 1 Isotope: fl, 2['2. Serial No.: )! lo Activity: Lo. I units:~ Instrument Response Acceptance Range [source cpm - bkg +/-20%):
Assay Date: 1 ?,. f 'Si;/, L:>
net cpm + 2~ net cpm -20% __ _
Source 2 Isotope:{. 5 ll7 Serial No.: Kl If/ l ~'If Activity: • 0 2- units~ Assay Date: ~c::. tnstrument Response Acceptance Range (source cpm - bkg +/-20%}: net cpm + 20% __ _ net cpm -20% ~--
3. Technician/Worker Performing Checks: Name: S'il~Va' K./,.-./f ~:r.-/ Title:-----~- Date: 10/110/1{r1me: /r;/')' . .
4. Site or Location: Site/Job:--~--------...,...-- Location Description: ____________ _
GPS Coordinates (when required): X-Coord: _________ Y-Coord: ________ _
6 . .es-r-s-----·-. ----(TS ,
·----.. ---·~----·---------·-, Remarks Use Acceptance Criteria Ii
!
d}et: BKg Bkg Source
No. Cnt (avg of 3) Cnt (1/2) Time {cprn) Time
Source , +/- 20% of
Response source Net (~g) cpm
Inst. Battery ! Time I Ambient Ca lib. Check Of I Temp.
current {Y/N) check (F) '
Initials and Comments I (add'! Info: temperature, inst. Condition, !
etc.) j N.~ ,J [Y/N) (Y/N)
.... 't%7S;rta'<· ·-··- ... -- .. ·· ..... ; . .. y y !~;) SJ-(,,.
i • m • - ..... •••• .J
"/ y r rz. a Sl- to I
'
1. Instrument designated check source is listed on calibration sticker. Record check source response {net cpm) prior to field deployment for llll check sources being used. 2. Source and Backgroun()' coL1nt rate should be determined from the average of three static counts at tha same locatfon. Repeat counts should be within 20%. If count
rate diverges significantly, perform addltfonal counts to evaluate Instrument stabllltv
!
Instrument Field Response Check Log
1. Instrument lnformatloni Raterneter: Make/Model:GJ£,.1f2t>fJ /I'd Clo /(81\ Detector 1: Make/Mode/: .J.rV"ffW.fil..-Detector 2: Make/Model:
2. Check Source Information:
SerJal No. 'A-Z-Z..l/ (,{_ Serial No.--~-Serlal No.----...,...-
Source l lsotope:·17l 2?2..- Serial No.: // b9 Activity: ..cro .. 1. units:~
Cal. Due Date: f4/µ ~
Assay Date; I z/1b /t 0
Instrument Response Acceptance Range {source cpm - bkg +/-20%): net cpm + 20% net cpm -20% ___ ~
Source 2 Isotope: Serial No.: Activity: ___ units: __ Assay Date: __ _ Instrument Response Acceptance Range (source cpm - bkg +/-20%): net cpm + 20% __ _ net cpm -20% __ _
3. ·Technician/Worker Performing Checks; Name: ST¢v{' /<11-')f".\A/\/ Title: _____ _
4. Siteorlocatlon: Site/Job: '3 ... 7---~----------
Date: I o/, b hs Time: /...5.:./ )' Location Deicription: .......... f&rt.__,_·-"--'f1'--'-----------
GPS Coordinates (when required): X-Coord: ________ ~ Y-Coord:_-'--------
lnstrument Field Response2 ---.-~----.. ····· Use Acceptance Criteria Remarks
BKg Bkg Source Source i1 +/- 20% of Inst.
I~ source Net Ca/ib. Battery ) Check (Y/N)
Time Of
check
j Ambient Temp.
(fl
Initials and Comments i {add'I Info; temperature, inst. Condition, I, Cnt {~ Cnt Response
Time (c~ Time Vi {~kg) n)e/t!.- _ #i.~lr- Net c_pm
-r 17
etc.)
I 1 cpm current
~--="""'(Y~/~N)"""""'··~-~(Y~/~N)~~"""""=*==·=-=-~""-=~·-=·~jF: ~"="«==='"""""'"""""'====~-=··~ Y V 15"/i{ S&,3 L
I ~~--r----r--------r------r--~-~-11-----+----~t----1------+--------lltf-----------~----1 1j
1. Instrument deslenated check source is listed on <:alibratlo n sticker. Record check source. response {net cpm} prior to fie!d deployment for al I check sources being used. 2. Source and Background count rate should be determined from the average of three static counts at the s.ame location. Repeat counts should be within 20%. If c:ount
rate diverges s!gnlficantly, perform additlona I counts to evaluate Instrument sta billty
Rev 110/18/15
J
1. Instrument lnformation1
R.atemeter: Make/Model: J...v0LVM. n Lf /. '"l--Detector 1: Make/Model: Lu I) l Utvl. o/Y· I o Bicron MlcroRem Meter:
Instrument Field Response Check Log
serial No. 2 G>:rn I Serial No./JlJ ! 11 z. 1 Serial No. fl t.1-'1 u
Cal.DueDate: CJ/z./rr...
Cal. Due Date: f,/tf V /., · 2. Check Source Information:
Source 1 Isotope: -fJ1 Z) Z-- Serial No.: // 0 Activity:~ units:~ Assay Date:£LDdl'"' Response Acceptance Range (+/-20%): uRem/hr +20% __ uRem/hr -20% __ net cpm + 20% net cpm -20% __ _
Source21sotope:(sU] SerialNo.: <({lEtJ-lff Activity: .07- units~ AssayDate:Mo · Response Acceptance Range (+/-20%): uRem/hr +20% __ uRem/hr ·20% __ net cpm + 20% __ _ net cprn -20% __ _
3. Technician/Worker Performing Checks: Name: ;;p::vt!' K--ct11S/11AtV Title:-~----
4. Site or Location: Site/Job:_J_.-'-2-_________ _
GPS Coordinates {when required): X-Coord: 7ff • &.> 7 1.../ 1 7"
I Instrument Field Response2
Location Desr.ri ption:_..fr;__,·-'-'-;?,,_,10'-----------
Y-Coord: tf 2 ; J.-f 8Vl O~
-Use Acceptance Criteria Remarks ~
Meter Bkg Bkg Counts Source Source Response +/-20% Inst. . Battery Time Ambient Initials and Comments
I Cnt (c.pm) or Cnt {gross cpm or source Ca fib. Check Of Temp. {add'l Info: inst. Condition, etc.)
lime uRem/hr) Trme uRerh/hr) gross cpm current (Y/N) check (aF) or uRem/hr (Y/N}
I (Y/N} I -- -·· ··-· -y v I Ratemeter IAttJ ·115q ·~ /,z,t,J \ q(.1 l/ Cf""- ocp< ·~z. Lf '71. i:rz... i Ratemeter I i'Jr1 c(I) ... q,,qi IMl•J 11 7- 1--fflf./.I\ '{ y f',Q./ 1'l J ~ Cf I' ' ( 51 ! Ratemeter / rfi ltJ ·1 )\ l_.. l 1A1rV J1>sl UJA 'f '{ 11 ·ic; s''i. s "//. 1. s·z., I Ratemeter I Mt.V 1 )(7,,, l ,,.,,,,,,1 [O ltJ ~'l UM y y I '3 it) 'i'f. -~ ({I? '"J I Bicron NA (;"'#f(ffifl NA J '7 .l..V fl. IN,- I v y Dq~o '3"7. c-{
! Bicron NA f,,, i/uz NA 11 , I/Ht"- -{ y )~'2r7 . i;- '(. 'S i Bicron NA 1 .... •'w ;} /1./(i' NA I { '"· 12./ //,,,. v y (!{.(9
I Bicron NA ...... I NA
I I
. . 1. Instrument designated check source 1s fisted on calibration stu::ker. Record check source response (net cpm) prior to field deployment for all check sources being used . z. 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 additional counts to evaluate Instrument stability
;:::;:==- t-=i
J
I ! I
I ; ' t i I I ! i i I I
I
Rev 110/18/15 Instrument Field Response Check Log
1. Instrument lnformation1
Ratemeter: Make/Model: Serial No. ____ _ Cal. Due Date: __ _ Detector 1: Make/Model: Serial No. ____ _
Bicron MfcroRetn Meter: Serial No.----- Cal. Due Date: __ _
2.. Check Source Information: Source l Isotope: serial No.: Activity: ___ units: __ Assay Date: __ _
Response Acceptance Range ( +/-20%): u Rem/hr +20% ___ uRem/hr-20% __ _ net cpm + 20%. ___ _ net cpm ·20% __ _
Source 2 Isotope: Serial No.: Activity: units: __ Assay Date: __ _ Response Acceptance Range {+/-20%): uRem/hr +20% ___ u Rem/hr -20% __ net cpm + 20%.~-- net cpm -20% __ _
3. Technician/Worker Performing Checks:
Name:.~-'--------ntle: ______ _ Date: fo/t r/t(nrne: ___ _
4. Site or Location: Site/Job:. ____________ _ Location Description: ____________ _
GPS Coordinates (when required): X-Coord:. ________ _ Y-Coord: ________ _
l 1 Instrument Field Response2 Use Acceptance Criteria Remarks
I Meter Bkg Bkg Counts Source Source Response +/- 20% Inst. Battery Time Ambient Initials and Comments l
! Cnt (cpm) or Cnt (gross cpm or source Ca lib. Check Of Temp. (add'l Info: inst. Condition, etc.) I Time uRem/hr) Time uRem/hr) gross cpm current (V/N) check (cF) I or uRem/hr (Y/N) l i (Y/N)
Rate meter jM(;) .ffS"f lPM -·
I~,,"' I 1 51 l cf,Vt y y J{Lfo 5t.c~ 1-n.nc j Ratemeter I rrt1iJ If(<;<{ c,fM } Mltv 17 L/l L {ff\A...
i Ratemeter 'Y y f <-'fl{' c:-ir_ {_ Cxl3"1
Ratemeter I Bicron NA NA
Bicron NA NA Bicron NA NA Bicron NA NA
l. Instrument designated check source is 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 sho.uld be within 20%. If count rate diverges
significantly, perform additional counts to evaluate instrument stabillty
I I i i 1 I
l i
I
I
I
App E-
Sub-Area 3.2 - Sample Data Sheets
·-···-f. ·~-- f
\,
-Date: iO~JtJ-() Project: Af\f .~6 @-OA
SAMPLE LOCATION DATA SHEET
Name: ~ Bfil..J V'\
Weather: c.Loocl~ ~_c_\ ___ _
1. Sample Area (SA):
SA Designation: 3. Z. Description: f=Zr\'VJ.CY"-d ~-~~~~~-------
SA Origin Location: Coord. System: -~· ~--SA Land Mark Description:~~- Coord: JJlf-: A.J/fr
I .P'f-1 '-0._--
2. Sample Location Data:
Sample Area ID: :3. 'l ~ \ "' Matrix: -5'0-1 \ -------- ----Location Coard: N Y '2, l/ ~ 0'1 ~
Alternate Location Measurements (distance from SA origin and Local Coord.) X Dist. from Origin (0,0)~} f\ Y Di~;t. from Origin: µf If\.
., .:...--+.---'------
Site Sketch Attached (Yes) ~) k~ &v~\ef ~ Sampte Location Description: f'c.v ~6~ ct'o() d-•i ""-~'O ~ &<''
Land Use:~r-M- · Soil Moisture (Wet, dry, etc):--d,,._~""·f1---Canopy Type: o:p-e (\
3 L t" R d' t" R d' oca ion a la U)Il ea mgs: 2x2 Nal B:cron Notes
(cpm) I! (uRem/hr) '
Count time l cm lm 1 cm
L~ (min) ' ..• ~ . r;_,....rr,.<;: -w -I rrP -·
;/7;,{q lkd'i {.Q__ 6 ---ff39 7 17-z.O - _. ____ ±=
"'
4. Sample Information: Sample Area ID: ~ _ Z..., 1.- R- r=-1, 5IU iu/,~ J, 2, 5
Soil Sample ID Sampling Description Calor (Surface litter type/depth, sample depth retention,
'S() ·,' ~"1v•"n 3.z..1.i2-I 1------'---'---<---'-----<-----+-----+-------;--;:_efusal, stone or rock, to o a h , erosion features
. r i't ::.o', \ 'n\O'-Y"' ;_ 'L- '· {2.- l.
o- '~ ' \.:h-i---.....>.I\ s.·z.1.1Z.S
Sample Recorded on Laboratory COC fonn and Conta'
Project: tJ ~Sf;--g. PA
Weather: {)ydCc.S~ l au \ I
. 1. Sample Area (SA):
SAMPLE LOCATION DATA SHEET
..-.-- - R Name: ! an ~•-'D'-'-'V\. •
SA Designation: 3 4 Z . L Description: fu~GY"b-SA Origin Location: ~-~ . ..B. '1¥/6M T13fi/11,._C_,_o..;_o_rd-_~S.:..:y=-st_e_m_:_/;ftf-_: -u.-,-,.,,_-.G-.. --=77f......-ta._ri.,...r<.,
SA land Mark Description: :{i;a '" Jv11d- &.fllr:__ Coard: N/& ~N"'-"l~~~---"0>1uh(
2. Sample Locati<Jn Data:
Sample Area ID; 9:,. ·2" L
Location Coord: \...\71;. U> 71Z8"7
Matrix: 'S:i\ L_
~ ~2/-f fr/(lU/
Alternate Location Measurements (distance from SA origin and Local Coord.) - {y fl ~..... -Rhc.c... o..{,0~ X Dist. from Origin (0,0)--tJj!A Y Dim. from Origin: JJ/ A- NI;.) I 1YL4.
Site Sketch Attached (Yes) ~
Sample Location Description: ~FC~G.~f"_,__M~l~O't~~d,----------------·----·--Canopy Type:~ n Land Use: hrrv. Soil Moisture (Wet, dry, etc):_12=---6f-+----
3. 0 L Rd' . R d' ocatmn a lation ea mirs: 2x2 NaI · B·cron Notes (cpm) (uRem/hr)
Count time l cm Im 1 cm lm (min) -· I 'WOW /{fi/7 -, . ___ $ J ~ 1,Lf 5 7 '1 g'/s,
4. Sample Information: Sample Area W: 2,. 2, Z.., tz. .. / -"L
D • f b D th escnp· ion >Y ep . Depth Soil Type Soil Sample ID Sampling Description
Interval {Org; clay; Color (Surface litter type/depth, sample depth retention, (cm) sand, etc) refusal, stone or rock, topography, erosion features)
0 -1'5 <;;oi\ "R~A"\ 3/l z..£., f Al/ fl:. 1-::.-~n ~')\\ Q~'"""'rs,'Z.., 1.., tz. • ~ "'[rt¥
.
~
Sample Recorded on Laboratory COC form and Container Labeled: ~ (N)
-, i
. SAMPLE LOCATION DATA SHEET
Date: [0-Jfo-1) Name:~. ~-Weather; 'S'.omy 1. Sample Area (SA):
SA Designation: ___ _3, 2..,~1clib . Description: Ftif1'V\. l Of\J SA Origin Location: ~'l\0.l.
SA Land Mark Description: rJ/t Coord. System: ____ _
Coord: ~~--- _J/~A: __ _
2. Sample Location Data:
Sample Area ID: 3,- 2, '3 · Matrix: _$.?~~L Location Coord: W ] 8'", l.17i../JO1 N '-/ 2. 1f <4 0 f6{ Alternate Location Measurements (distance from SA origin and Local Coord.) <;l.l'O .(4:. ~"' dt\'lrC~ X Dist. from Origin (0,0)_,J)_il_ Y Di~t. from Origin: ~!"+Q_,_fr"""---
Site Sketch Attache.d (Yes) § Sample Location Description: . &.fl"l'\. I [()1,,J"C'.'.rrd loy wd. -pi k
Canopy Type: 0 pen Land Use: ~}1d ___ Soil Moisture (Wet, dry, etc): TJ01 .... _ 3 Lo f R d" ti R d" . ca ion a 1a on ca mgs:
2x2 Nal B'.cron Notes. {cpm) (uRern/hr)
Count time \cm lm lc~l lm 1:
(min) ....
I ///-:,\ 10/pf lo r 11 ... I llo'i .:I_Q_.:i I -
I
~ ___ E_ 4. Sample Information: Sample Area ID: S. '2..: ·3, \Z · \-'Z..
D . ti b D th cscnp on 1y ep1 : Depth Soil Type Soil Sample ID Sampling Description
Interval (Org; clay; Color (Surface litter type/depth, sample depth retention, (cm) sand, etc) :efusal, stone or rock. topoITTaphy, erosion features)
c _.. 15 ::O,\ ~¥[ ......... 3.l.3.\'Z.., I -So,~ ...-.:..cx:::C \ri ¥11,t~~ ~ l'l '§i,C<.~
I? '4!0 . -So: { lS.i;.vV"I 3 :z. ;~ . IZ .'L w IPr -
Sample Recorded on Laboratory COC form and·Container Labeled: (Y) (N)
SAMPLE LOCATION DATA SHEET
Project: ;Jy St.fl.'DA ..---:- . "77 Name: fnn ·Dfui..,..)Yl
\
SA Designation: 3, L-. Description: ~r~l<Yl-cl ~--"--'~~.-......---~----
SA Origin location: Coord. System:
SA Land MarkDescriplion: -r1101Y.:S6"''\ (.,OJ'yu..r- ~---- Coord:
2. Sample Location Data:
Sample Area ID: --'3=·'-· 2..~, _t.-J_,___ Matrix: ~ o ~ \
Location Coord: v.J 7'6•U1'1 I q <6
Alternate Location Measurements (distance from SA cirigin and Local Coord.) X Dist. from Origin (0,0) Y Di:;t. from Origin: ---~
Site Sketch Attached (Yes) @)
Sample Location Description: __,_h-=c:r~m_,___l~~---"b'--;;;'--""v_=C_._·_P--1=<~-----------
Canopy Type: 0 P & /\J Land Use:~\. __ Soil Moisture (Wet, dry, etc):__l~
3. Location Ra .. diatmn Rea d' mgs: 2x2NaI ~ B'cron Notes · (cpm) (uRem/hr)
Count time 1 cm lm I~ ;1 ~m r {min) ~-~
I 7777 ll-f 43 J /7Ci'1 1112'_1__ =t=~ ..
;
'
ff 1-..
4. Sample Information: Sample Area ID: 3. 2, 'i, f2- / J-5
Depth Soil Type Soil Sample WI Sampling Description · Interval (Org; c1ay; Color I (Surface litter type/depth, sample depth retention,
1--~C.:..:.cm~) .---1_s_an_d....;.,_et_c-'-}-+-~--~-------+; ... ~efusal,_ stone or rock, to oo-ra hv, erosion features)
1--D_-_1_c;;-_...+.-~~i•"----'-+---~4=-'-""'-'-'-.=L.~~--+-So\~~:Q~ C -
µ1~'5--3"-'0""--+.:;....:-'-'-~--t=----t.=..:...;"'-'---~-"::---~jJ ~----------------; 30-U.o
Sample Recorded on Laboratory COC form and Container Labeled:
