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Columbia <br /> Analytical <br /> ServxceSmc <br /> An Employee-Owned Company <br /> 5090 Caterpillar Road , <br /> Redding,CA 96003 <br /> COOLER RECEIPT FORM <br /> - - -ProlectlCiient•� yd4 A,e. _ .�•cJ1�24�u �•�� C - —-Batch No.: - -� 6 -- ------ A <br /> 1. Cooler(s)/Sample(s) received on: Shipped via, -oe7 <br /> Shipping Bili#(s)• A , <br /> 2. Radiological Screening by A Rejected <br /> 3. Custody seals on outside of cooler- YES NO A <br /> If yes,where? Front Rear Lt Side Rt Side <br /> Seals Intact- YES NO ' <br /> COOLERStMPLE P OCESSING <br /> 4. Sample Processing/Tagging by: <br /> 5 Cooler(s)/Sample(s)Temp's --` ' <br /> (or) <br /> Temp Blank(if present): <br /> 6. Type of paclung material(circle) Ice Blue Ice Bubble Wrap Bubble BagsZip Locks Webbing <br /> Other <br /> 7 Custody papers properly-flied out(ink.,-signed,-dated,-released;etc.)? =NO <br /> 8. Containers arrived in good condition(unbroken,-leaking,etc.)? EE <br /> 9.- Container labels complete i e analysis, reservation,date/time,etc.)? - NO <br /> p ( Y p <br /> 10. Container labels and tags agree with custody papers? E) NO ' <br /> 11. Correct types of containers used for the tests indicated'► NO <br /> a.) Adequate sample received? If not,note on Exception Report ES NO ' <br /> 12. Containers supplied by: CAS Aither <br /> 13. Preserved containers received with the appropriate preservative? (YES NO N/A <br /> PH Z (or) See pH log ' <br /> . r <br /> 14. VOA vials free of air bubbles? �No NIA <br /> 15. Trip Blank preparation date: CAS Other <br /> ed to the freezer- Date: Time- <br /> See <br /> A ' <br /> 16 Soil samples transfers <br /> See Exception Report for discrepancies. <br /> Rev 8/1/2002/de <br /> 0044 <br />