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�'D '�'°�' WORK ORDER #: 04 -UIE] - ENIFIM <br /> Cooler _ of I <br /> SAMPLE RECEIPT FORM <br /> CLIENT: ki-FF DATE:--nze Zel <br /> TEMPERATURE - SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY (Other than Calsclence Courier): <br /> Chilled, cooler with temperature blank provided A-( °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 Initial �v <br /> CUSTODY SEAL INTACT: <br /> Samples) Cooler— JZ No(Not Intact) Not Applicable (NIA) <br /> Inrtial <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chau44X-Custody document(s)received with samples <br /> Sample container b <br /> laelonsistent with custod - �/ •.... .- - ---- <br /> —- (-s)--cY papers. .. .. =�� :... ... <br /> Sample container(s)intact and good conditjon _ <br /> ......•.•. <br /> Correct containers for analyses requested LZ <br /> Proper preservation noted on sample iabel(s) <br /> VOA vial(s)free of headspace <br /> Tedlar bag(s)free of condensation <br /> Initial _ aq- <br /> COMMENTS: <br />