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'f Columbia <br /> Analytical <br /> S erviceSin <br /> An Employes-Owned Company <br /> 5044 Caterpillar Road <br /> Redding,CA 96003 <br /> COOLER RECEIPT FORM <br /> Project/Client• ;Lr/4 , Batch No g 7S _ <br />' I Cooler(s)/Sample(s) received on /1-9 3 Shipped via l <br />' shipping Bill#(s)• <br /> z. Radiological Screening by _ - c`cop b er Rejected <br /> 3. Custody seals on outside of cooler YES N/A <br />' If yes,where9 Front Rear Lt Side Rt Side <br /> Seals intact, YES NO <br /> COOLERS PLE PROCESSING <br /> 4. Sample Processing/Tagging by: <br /> -i�2 . <br /> 5 Cooler(s)/Sample(s)Temp's: <br /> (or) <br /> Temp Blank(if present) <br /> 6. Type of packing material(circle) cc Blue Ice Bubble Wrap Bubble Bags CpI�ck)s Webbing <br /> Other <br /> 7. Custody papers properly filled out(ink,signed,dated,released,etc)? ES NO <br /> 8. Containers arrived in good condition(unbroken, leaking,etc.)9 NO <br /> 9. Container labels complete(Le analysis,preservation,dateltime,etc.)? � NO <br /> 10. Container labels and tags agree with custody papers? YES NO <br /> 1 I Correct types of containers used for the teas indicated? )PIES) NO <br /> a.) Adequate sample received? If not,note on Exception Report. NO <br />' 12. Containers supplied by. CAS Cher <br /> 13. Preserved containers received with the appropriate preservative? NO NIA <br />' pH Z (or) See p14 log. <br /> i' <br /> 14 'VOA vials free of air bubbles? NO NIA <br /> 15. Trip Blank preparation date � CAS Oth /A' <br /> e� <br /> 16. Soil samples transferred to the freezer: Date; Time• -------- <br /> ltev 8/1R(Ip2/ds See Exception Report for discrepancies. <br /> 0057 <br />