Laserfiche WebLink
�,ctesscv <br /> M <br /> WORK ORDER <br /> Cooler of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: DATE: 7 <br /> i <br /> TEMPERATURE— SAMPLES RECEIVED BY <br /> CALSCIENCE COURIER: LABORATORY (Other than Calsdence Courier) <br /> Chilled, cooler with temperature blank provided —4-0 C Temperature blank <br /> Chilled, cooler without temperature blank It °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 In't;al <br /> CUSTODY SEAL INTACT: / <br /> Sample(s) Cooler N No(blot Intact) Not Applicable(NIA) <br /> Initial <br /> . SAMPLE CONDITION: <br /> Yes No NIA <br /> Chain-Of-Custody document(s) received with samples l <br /> Sample container label(s)consistent with custody papers l <br /> Sample container(s)intact and good condition <br /> Correct containers for analyses requested <br /> Proper preservation noted on sample label(s) <br /> VOA vial(s)free of headspace r <br /> I ediar bdg(s)free of condensation <br /> Initial <br /> COMMENTS. <br /> -e5�e �z <br />