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SEP-03-2002 11 23 CALSC I EhICE 714 B94 7561 P.06/06 <br /> 0999" <br /> AMp"iWORK ORDER#: 02.L�I © " L'J 9 Ell R1 <br /> . �abar�torrsa, ,ems <br /> Cooler of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: DATE: 1? 94" <br /> TEMPERATURE-- SAWYLES RECEIVED BY; <br /> CALSCjENCE COURIER: LABORATORY(Other thillft CalmhM00 Courier): <br /> Chilled, cooler with temperature blank provided. 3 °C Temperature blank. <br /> Chilled.cooler wmout temperature blank. 17 IR thermometer. <br /> �— Chilled and placid in Cooler with wet ice Ambient temperature <br /> Ambient and placed in cooler with wet ice. <br /> Ambient temperature <br /> w <br /> 'C Temperature blank Intel: <br /> cusTODY SEAL INTACT. <br /> Cooler No Not Intact) Not Applicable(NIA): <br /> initial: <br /> SAMPLE CONDITION: Yes No WA <br /> Cham-Of-Custody documents) received with samples .. 1,.:.. .... .••.... <br /> Sample container label(s)consistent with custodY papers .. ✓ .. .... ....... <br /> sample container(s)intact and good condition. . 1/ ..• .. . ... <br /> Correct containers for analyses requested .. . ' .,. ✓ ... .... <br /> Proper preservation noted on WON)els) . ..... ... ... .fir... .... ....... <br /> VOA viage)tree of headspace. .... .. ..... . ........... ... .... ....... <br /> Tedlar bag(s)free of condensation - ._ . . ......... ,... . . . ... ....--•• .... <br /> Inidat <br /> COMMENTS: <br /> TOTAL P.06 <br />