Laserfiche WebLink
Page 18 of 18 <br /> WORK ORDER #: OBJ - F21 © - E] a a FTI <br /> Cooler of N <br /> SAMPLE RECEIPT FORM <br /> CLIENT:_!\LV—' DATE: <br /> TEMPERATURE — SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER LABORATORY (Other than Calscience 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 Initial <br /> CUSTODY SEAL INTACT: <br /> Sample(s) Cooler No(Not Intact) Not Applicable (NIA) <br /> Initialdk <br /> w <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chain-Of-Custody document(s)received with samples .. <br /> Sample container label(s)consistent with custody papers �... , <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 41 _ .� <br /> Tedlar bag(s)free of condensation .. l <br /> Initial <br /> COMMENTS: <br />