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PPR-29-201 14 25 P.96/07 <br /> sMMer <br /> WORK ORDER M. 03 - <br /> Cooler I of �w <br /> SAMPLE RECEIPT FORMA <br /> CUENT: <br /> • na-rl�: Z� 0 3 <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY (Other than Calacienee courier): <br /> Chilled,cooler with temperature blank provided . °C 7emperatura blank <br /> Chilled, cooler without temperature blank °C IR thermometer <br /> Chilled and placed in cooler with wit 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 /> Sampla(s) _ Cooler No(Not Intact) Not Applicable(N/A) <br /> Initial <br /> SAMPLE CONDITION'. Yes No NIA <br /> Chain-X-Custody document(s)received with samples .. �.; . .----�-- <br /> sample contafner label(&)consistent with custody papers No,, <br /> . ... <br /> Sample container(s)intact and good condition ., ... <br /> Con containers for analyses requested ,, ., .... •'- <br /> Prope/preservation noted on sample label(s) .. . ... —�-- <br /> VOA vial(s)free of headspace —�--' •• .. . , <br /> Teolar bag(s)free of condensation ... ... - " � <br /> initial <br /> COMIiAENTS: <br />