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APR-14-2003 12 13 P.06/W <br /> fZz lawWORK QRDER#: 030 <br /> h.a� <br /> Cooler ' Of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: iaiFIZ GATE: <br /> TEMPERATURE—SAMPLES RECEIVE© BY: <br /> CALSCIENCE COURIER: LABORATORY(Otheir than Ca eienoe Courier): <br /> Chilled,cooler with temperMrs blank provided. "C Temperature blank <br /> Chilled,cooler Without temperature blank. a IR thermometer <br /> Chilled and plooed in 000ler with wet ice Ambient temperature <br /> Amblent and plata in cooler with wet Ice. <br /> Ambient temporeture <br /> °C Temperature blank. Initial: <br /> CUSTODY SEAL INTACT: <br /> sample(s): Cooter. No(Not Intact) Not Applk:abte(NSA). <br /> Initial. <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chain-Of-Custody document(s)received with samples .. ... _ /� ... ..-.. <br /> Sample container Iabel(s)consistent with custody papers ^ -- <br /> Sample container(s)int>ict and good condrdon. ,.. .. ..... .. .., .... <br /> Correct axft nem for analyses requested... . .. .. . .. .... <br /> Proper preservation noted on sample label(s). . ., .. .. ....,. �, <br /> VOA vials)free of hsadspace. . .. . . ,,,�,^ ...... .. .. <br /> Tedier bag(s)tree of condensation. .... .. .. ,. i <br /> Initiallialtlat <br /> COMMENTS: <br />