Laserfiche WebLink
Page 10 of 10 <br />t� WORK ORDER #:08 - U N - [�j Fil I ff <br />! Cooler of <br />SAMPLE RECEIPT FORM <br />CLIENT: f�✓eS?.err t� Ss2lt/r (� Lvl C <br />TEMPERATURE - SAMPLES RECEIVED BY: <br />CALSCIENCE COURIER: <br />Chilled, cooler with temperature blank provided. <br />Chilled, cooler without temperature blank. <br />Chilled and placed in cooler with wet ice. <br />Ambient and placed in cooler with wet ice. <br />Ambient temperature. <br />DATE: a6/Ds- <br />LABORATORY (Other than Calscience Courier): <br />� — ° C Temperature blank. <br />t` S °C IRthermometer. <br />Ambient temperature. <br />I° C Temperature blank. Initial: I <br />CUSTODY SEAL INTACT: <br />Sample(s): Cooler: No (Not intact): Not Present: <br />Initial: <br />SAMPLE CONDITION: <br />Chain -Of -Custody document(s) received with samples ......................... <br />Sampler's name indicated on COC ................................................. <br />Sample container label(s) consistent with custody papers ..................... <br />Sample container(s) intact and good condition ................................... <br />Correct containers and volume for analyses requested ....................... <br />Proper preservation noted on sample label(s)..................................... <br />VOA vial(s) free of headspace........................................................ <br />Tedlar bag(s) free of condensation................................................... <br />Yes No N/A <br />✓ <br />_� ...... <br />....... ....... . <br />L7 ..... , . <br />—L,7 ....... ....... <br />V <br />✓ <br />Initial: <br />COMMENTS: <br />