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� Y <br /> Columbia <br /> Analytical <br /> Servicesme <br /> An Employee-Owned Company <br />' 5090 Caterpillar Road <br /> Redding, CA 96003 <br /> COOLER RECEIPT FORM <br /> 1 Project/Client •C") �, .v Batch Number D 9,;74U <br /> 1 Cooler(s)/Sample(s)received on 214eLl Shipped via: &-Q-0-,LP s. nz_ <br />' Shipping Bill#(s) 01 <br /> 2 Radiological Screening by: Accli�t Rejected <br /> 3 Custody seals on outside of cooler. YES � N/A <br /> If yes,where? Front Rear Lt Side Rt Side <br /> rSeals intact. YES NO <br />' COOLER/SAMPLE PROCESSING <br /> 4 Sample Processing/Tagging by 0; <br /> 5 Cooler(s)/Sample(s)Temp 's 6c.C-1 <br /> (or) <br /> Temp.Blank(if present) <br /> 6 Type of packing material(circle) cc Blue Ice Bu ble Wrap Bubble Bags Zip Locks Webbing <br /> - <br />' 7. Custody papers properly filled out(ink,signed,dated, released,etc.)? NO <br />' 8 Containers arrived in good condition(unbroken,leafing,etc)? YES NO <br /> 9 Container labels complete(i.e. analysis, preservation,date/time,etc.)? Y S NO <br />' 10 Container labels and tags agree with custody papers? NO <br /> 11 Correct types of containers used for the tests indicated? YES NO <br /> a.) Adequate sample received? If not,note on Exception Report YES NO <br /> 12. Containers supplied by CASOthe <br /> 13. Preserved containers received with the appropriate preservative? YES NO N7 <br /> pH: (or) See pH log <br /> 14 VOA vials free of air bubbles? YES NO <br /> 15 Trip Blank preparation date CAS Other "I <br /> 16. Sol]samples transferred to the freezer. Date: Time NIA <br />' Rev 8/1/2002/dc See Exception Report for discrepancies. <br /> 0106 <br />