Laserfiche WebLink
Page 6 of 6 <br /> i�r rte_ <br /> WORK ORDER #: 05 b [DID _ 16 11 ® 4E <br /> Cooler of 1 <br /> SAMPLE RECEIPT FORM <br /> CLIENT: lA DATE: <br /> TEMPERATURE -- SAMPLES RECEIVED BY• <br /> CALSCIENCE COURIER LABORATORY (Other than Caiscience Courier). <br /> Chilled, cooler with temperature blank provided 2, 'C Temperature blank <br /> Chilled, cooler without temperature blank DC 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 lnitial �Z <br /> CUSTODY SEAL INTACT: <br /> Sample(s) Cooler No (Not Intact) Not Applicable (NIA) <br /> Initial <br /> SAMPLE CONDITION: <br /> Yes/ No NIA <br /> Cham-0f-Custody document(s) received with samples <br /> 4, <br /> Sample container label(s)consistent with custody papers <br /> Sample container(s) intact and good condition <br /> Correct containers for analyses requested �W <br /> Proper preservation noted on sample label(s) <br /> VOA vial(s)free of headspace �— <br /> Tedlar bag(s)free of condensation �— <br /> Initial <br /> COMMENTS: <br /> s <br />