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DEC-11-2002 16 13 CPLSC I ENCS 714 894 7501 P.08/09 <br /> Fe+f� <br /> WORK ORDER #: D2-Q [9 - on EJ El LJ <br /> Cooler of f <br /> SAMPLE RECEIPT FORM <br /> CLIENT: � DATE: <br /> TEMPERATURE—SAMPLES RECEIVED EY: <br /> CALSCIENCE COURIIIR: LABORATORY(Other than Calaciance Courier): <br /> Chilled,cooler with temperature blank pnMded °C Temperature blank <br /> Chilled, cooler without temperature blank i, _°C IR thermometer <br /> Chilled and placed In cooler with wet ire Ambient temperature <br /> Ambient and placW in cooler with wet ice <br /> Ambient temperature <br /> °C Temperature blank. Initial* <br /> CUSTODY SEAL INTACT: <br /> Samples) Cooler No(Not Intact) Not Applicable(NIA) <br /> Irubal <br /> SAMPLE CONDITION: <br /> Yeah No NIA <br /> Chain-=ustody doamtent(s)received with samples //. . . . <br /> - Sam <br /> pie c�an#arner latael(s)consistent with rody papers <br /> I <br /> Sample container(s) intact and good condition <br /> Correct containers for analyses requested :7"""f/ - <br /> ry - - <br /> Proper preservation noted on sample label(s) <br /> VQA%nal(s)free of headspace .. ...... / <br /> Tedlatr bag(s)tree of condensation <br /> Initial, L.-- <br /> COMMENTS: <br />