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WJAN-06-2B3 12 47 CPL9CIETICE 714 894 7501 P.06/W <br /> �re�14K1�nF# - <br /> i •� �* WORK ORDER#: © �- <br /> D 0 0 <br /> ante rtoz. Inc. <br /> Cooler _ t - of ii <br /> SAMPLE RECEIPT FORM <br /> CLIENT: kJ FF DATE: 12- / 9"7 lot <br /> TEMPERATURE—SAMPLES RECENED BY; <br /> CALSCIENCE COURIER: LABORATORY(Other than Caiscience CouriO <br /> Chilled,cooler with temperature blank provided _°C Tennpand"blank <br /> Chilled cooler wfflhout tenWrelure blank !. _°C IR themwneter <br /> _...__ Chilled and placed In cooler with wet ice. Ambkwd temperature. <br /> Ambient and placed In cooler with wet kxL <br /> Ambient temperature <br /> *C Tnmverature blank. InMW: <br /> CUSTODY SAL INT CT: <br /> Sample($)._ Cooler No(Not Intact)._ Not Applioable(NIA)• _ <br /> initial: <br /> SAMPLE CONDITION: <br /> yes No WA <br /> Chaln-Of-Custody 0oammi(s)received with samples............. . . . .... ��....... ...... <br /> Sample container label(s)consistent with custody papers......... ... ... ... ....... ....... <br /> Sample containers)Intact and good condition ........ ... Ty�,,,,_....... . ..... <br /> Correct containers for analyses retiuested. _�L..... .......... <br /> � <br /> gropes presarvabon noted on sample label(s).. .. ... ....................... ....... <br /> VOA vlW(s)free or headspsce. ...... . . . . ....... ..,.... <br /> Tedler bag(s)hes of condensation. ... _ .. .,.._.. <br /> COMMENTS: <br />