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Qualifying Constituents <br />Alpha <br />SHA <br />Version 4.0 <br />Sample Hazard Assessment <br />Client Sample ID <br />� <br />-o n <br />9/5/2002 <br />❑ <br />V2 7 <br />wail I.� <br />Qualifying Constituents <br />Alpha <br />❑ <br />ly-- - MI - <br />Use on — <br />5. Research Samples <br />-o n <br />Beta <br />❑ <br />G. Preconstruction Soils <br />YES <br />Acid <br />Tritium <br />❑ <br />IBase <br />Per Sample Basis: Are rad levels detectable by meter? <br />None of the hazards listed above are present in the sample. <br />❑ Check here, if WDR is not available (For HWM use only). <br />I certify, to the best of my knowledge that i ormati n provi e a ove is accurate and pmplete. <br />Authorized Individual (Signature/Date): A I ,, , <br />�, = <br />or-Sa pler <br />ly-- - MI - <br />Use on — <br />5. Research Samples <br />SHA Received by Date: <br />CES COC #: <br />Qualifying Constituents <br />G. Preconstruction Soils <br />YES <br />NO Comments <br />Was Hazard Assessment Control (HAC) necessary <br />7. Environmental Soils <br />8 Tna or Fi•-2Id Blanks <br />❑ <br />Per Sample Basis: Are rad levels detectable by meter? <br />❑ <br />❑ Check if N/A <br />Exceeds 30,000 CPM <br />4. Field or Bulk Gamma <br />❑ <br />❑ <br />Exceeds 5 mR/hr <br />❑ <br />❑ <br />30 cm 1 ft <br />Exceeds 1 micro Curie <br />❑ <br />❑ <br />Comments: <br />I certify, to the best of my knowledge that information provided bove is accurate and complete. <br />Sampler (Signature/Date): <br />For CES Use Only <br />CES login personnel must notify CES OPS PEL if rad levels exceed 1 micro Curie <br />SHA is not required for. <br />5. Research Samples <br />SHA Received by Date: <br />CES COC #: <br />1. Berms <br />G. Preconstruction Soils <br />(initials): <br />2. Retention Tanks <br />3. PE Samples <br />7. Environmental Soils <br />8 Tna or Fi•-2Id Blanks <br />/ <br />v V <br />4. Field or Bulk Gamma <br />for ,lnruvii n( rontnd purpoits, user SIIA f.L evssw that JIt working copies Jet Jl IiM to c­,olt elea twnit version. <br />7iIIJI.gJ(✓IIJI_UNII(/'i i/QA doc_- fUst„of.. QA.-Docs.hl I <br />