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1 <br /> Columbia <br /> Analytical <br /> Sery ceS <br /> An Employee-Owned Company <br /> 5094 Caterpillar Road ' <br /> Redding,CA 96003 <br /> COOLER RECEIPT FORM <br /> - - Project/Client: ot"_J 'D CT- -� - - _ --- -- - —— Batch No S Z`( <br /> 1. Caoler(s)/Sample(s) received on- 14-44-03 Shipped via: C=J 5 - tj <br /> Shipping Bill 9(s)• c 0vk-t•At !3 S ,-t I s ' <br /> 2 Radiological Screening by: <br /> (AcceptablrO Rejected <br /> 3 Custody seals on outside of cooler: YES NO N/A <br /> If yes,where? Front Rear Lt Side Rt Side <br /> Seals intaet. YES NO <br /> COOLER/SAMPLE PROCESSING ' <br /> 4. Sample Processing/Tagging by <br /> 5. Coolers)/Sample(s)Temp's- <br /> (or) <br /> emp's(or) <br /> Temp Blank(if present): <br /> 6. Type of packing material (circle): Ice Blue Ice Bubble Wrap Bubble Bags Zip Locks Webbing <br /> Other: , <br /> 7. Custody papers properly fllcd put(ink;signed;dated,-released,-etc.)? Y —N0 <br /> —8. Containers arrived-in goodcotiditinn(unbroken;leaknig;etc.)? (YE5 ANO ' <br /> 9. Container labels complete @i analysis,preservation,date/time,eta)? - - Lim) -NO -- <br /> 10 Container labels and tags agree with custody papers? YE NO ' <br /> 11 Correct types of containers used for the tests indicated? 6;� NO <br /> a.) Adequate sample received? If not, note on Exception Report. YE NO ' <br /> 12. Containers supplied by 6 b,-vt sf S IC,e ve s) CAS Other <br /> 13 Preserved containers received with the appropriate preservatives r YES NO <br /> PH- (or) See pH log. ' <br /> 4 14. VOA vials free of air bubbles? YES NO <br /> 15, Trip Blank preparation date: CAS Other N/ ' <br /> 16. Soil samples transferred to the freezer, Date Time: N1 <br /> See Exception Report for discrepancies. <br /> Rev 8/112002/ds <br /> UnD4 <br />