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JIJIV--05-2003 11:3:3 P.06/07 <br /> WORK ORDER#: 03 -IaR - HAM In <br /> Cooler I of I <br /> SAMPLE RECEIPT FORM <br /> CLIENT: AlrF Aw?r-lckl DATE: S fA 3 <br /> TEMPERATURE-SAMPLE$ RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY Other than Caleclence Courier): <br /> ChUled,coder with temperature blank provkled _°C Ternporature blank <br /> Chilled,cooler 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 /> Ambrent temperature <br /> C Temperature blank. In>tial <br /> CUSTODY SEAL INTACT: <br /> Sample(e) � Cooler: No(Not Intact)- Not Applicable(NIA) <br /> initial: <br /> SAMPLE CONDITION: <br /> Yes No N!A <br /> Chain-Of-Custody documents)received with samples,,. .. .... ... <br /> Sample container isbel(s)consistent with custody papers.... .. .... ..... <br /> Sample containers) intact and good condition . , . <br /> Correct containers for analyses requested .. .. . . ... .. _ . ...., T <br /> Proper presenraW noted on sample label(s) .... ... . , ..._..__.� --- -. .. . <br /> VOA vials)free of headspace <br /> Tedlar bags)free of condensation... ... . .......... .. . .... . . ... .. . . <br /> ' Initial; <br /> COMMENTS: <br />