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MRY-2EIi-2M 17:10 P.iB v <br /> r WORK ORDER#: 03 -1a[A - HUNT <br /> Nae: • <br /> Cooler,�_ of <br /> SAMPLE RECEIPT FORM <br /> CL-LENT: 141 � DATE: ��-/N-1103 <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than Cslscienae Courier): <br /> ChrMed, Cooler with temperatlJre blanc pmWed °C Temperature blanc <br /> Chilled.cooter 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. t+ <br /> CUSTODY SEAL INTACT: <br /> SamPw(s) Cooler_&/_ No(Not Intact) Not Applicable(NIA) <br /> Initial: K C. <br /> SAMPLE CONDMON: <br /> Yes No NIA <br /> Chain-0f-Custody document(a)received with samples ... . .... . �.... .. .. .... <br /> Sample container tabes)_oonsiatent with custody Papas..... . . .......... <br /> Sample container(s)Intact and good oondition . . .. % ... .. <br /> Correct containers for anetyses requested <br /> Proper preservation noted on sample lsbel(s}... .,. ... ... _ ..•_.. .. . <br /> VOA V181(s)[res of headspace. .. ... ... .... <br /> Tedtar bag(s)free of condensapoa .... . ...... . ...... . .. _ .- - - .. ...._y901 <br /> inlft HCO _ <br /> COMMENTS: <br /> 6" /ff�s <br />