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SEP-18_2002 12 12 CAaL.SCIENCE 714 894 7501 P 07/0? <br /> i��Clsisc� , <br /> fro nn7ffirrtal <br /> WORK ORDER #: 02-E 91 _ 5 E 3 <br /> Cooler k of I <br /> SAMPLE RECEIPT FORMA <br /> Ci_IEIVT: ( 1 f 3 4 Z._. <br /> �,.. DATE:____q� I <br /> 1 E NIPERATURE —SAMPLES RECEIVED BY: <br /> �ALSCIENCE COURIER: LA130RATORY(Other than CuIselence Courier): <br /> — Chilled, cooler with temperature blank provided , °C Temperature blank <br /> Chilled, cooler without temperature blank °C IR thermometer, <br /> _ Chilled and placed In cooler with wet ice, Ambient temperature <br /> Ambient and placed In cooler with wet ice <br /> Ambient temperature <br /> °C Temperature blank Ingo) <br /> "LISTODY SEAL INTACT: / <br /> J, fe(s) ., Cooler V No(Not Intact) Not Applicable(NIA). <br /> Initial: <br /> Ask <br /> f AMPLE CONDITION: <br /> Yes No NIA <br /> "a"I Of-Custody document(s)received with samples.. . . ... .. - , <br /> �ntrle container labels) consistent with custody papers- —�` ... <br /> ln-; IN container(s)intact and good condition- <br /> if, <br /> ondition_if.t containers for analyses requested . V. <br /> preservation noted on sample label(s) <br /> JP vial(s) free of headspace • - - ... , . ... •�.....,, v <br /> ,iia, bag(s) free of condensation .. .. . . <br /> Inrtl�i. i <br /> ONIMENTS: <br /> TOTAL P 07 <br />