+------------------------------------+---------------------------------+
| ## M&TE Evaluation Report          |                                 |
+------------------------------------+---------------------------------+
| **Section I.**                     |                                 |
+------------------------------------+---------------------------------+
| M&TE Identifier:                   |                                 |
+------------------------------------+---------------------------------+
| M&TE Description:                  |                                 |
+------------------------------------+---------------------------------+
| On the M&TE identified above       |                                 |
|                                    |                                 |
| > was out of tolerance.            |                                 |
| >                                  |                                 |
| > could not be calibrated.         |                                 |
| >                                  |                                 |
| > could not be located.            |                                 |
|                                    |                                 |
| Was the device used to collect     |                                 |
| data?                              |                                 |
|                                    |                                 |
| > No, Complete Section III of this |                                 |
| > form.                            |                                 |
| >                                  |                                 |
| > Yes, determine if the data       |                                 |
| > collected were affected by the   |                                 |
| > identified condition and         |                                 |
| > document the results in Section  |                                 |
| > II of this form.                 |                                 |
+------------------------------------+---------------------------------+
| **Section II.**                    |                                 |
+------------------------------------+---------------------------------+
| Evaluation:                        |                                 |
+------------------------------------+---------------------------------+
| > a\) Identify the data collected: |                                 |
| >                                  |                                 |
+------------------------------------+---------------------------------+
| > b\) Identify the processes       |                                 |
| > monitored:                       |                                 |
+------------------------------------+---------------------------------+
| > c\) Identify the notebooks       |                                 |
| > reviewed:                        |                                 |
+------------------------------------+---------------------------------+
| d)  Conclusion: The validity of    |                                 |
|     results obtained with the M&TE |                                 |
|     or Standard and the            |                                 |
|     acceptability of data          |                                 |
|     collected since the last       |                                 |
|     calibration have been          |                                 |
|     evaluated as required, and is  |                                 |
|     documented as follows:         |                                 |
|                                    |                                 |
| > data are acceptable (complete    |                                 |
| > Section III, below).             |                                 |
| >                                  |                                 |
| > data are unacceptable (initiate  |                                 |
| > nonconformance report and        |                                 |
| > complete Section III, below).    |                                 |
| >                                  |                                 |
| > Nonconformance report number:    |                                 |
| >                                  |                                 |
+------------------------------------+---------------------------------+
| **Section III.**                   |                                 |
+------------------------------------+---------------------------------+
| The impact of the identified       |                                 |
| condition has been evaluated.      |                                 |
|                                    |                                 |
+------------------------------------+---------------------------------+
|                                    |                                 |
|                                    |                                 |
| > Print name and title Signature   |                                 |
| > Date                             |                                 |
+------------------------------------+---------------------------------+
| QP-5.2                             | Los Alamos                      |
|                                    |                                 |
|                                    | Environmental Restoration       |
|                                    | Project                         |
+------------------------------------+---------------------------------+