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Paige 45 of 46 __ Page 46 of 46 <br /> i0L6-969-6 L aryd.,OYO <br /> �ralsciBnca - <br /> Q Y ArtWroirmmavd WORK ORDER#: 07 - © a- ❑D ® ❑5 5❑ <br /> 0 y t^ a irs$FYe[Priez,Inc. <br /> s _-tea Q Cooler I of I <br /> r tlEUll(6)Hdi c r F 0 <br /> o (SI UD10*1-01)SWA SAMPLE RECEIPT FORM <br /> P O o y <br /> (n lsalz�as9u-vssldOn)r� o a <br /> :) = e p e= moo w y _ CLIENT: IPN� YQCI c- DATE: 10II2/6-7- <br /> OQ M 5 �..} J (XL6/180L09)slelaW ZZl — �+ v <br /> z W❑ i ooczelm(oles)9vNd = 9 = \- TEMPERATURE-SAMPLES RECEIVED BY: <br /> v e to <br /> Q ❑ Q (yg0g)seed CALSCIENCE COURIER: LABORATORY(Other than Calecience Courier): <br /> O Chilled,cooler with temperature blank provided. 5,3 °C Temperature blank. <br /> v o a W (v181e)sspopsed <br /> 0 .❑ F Chilled,cooler without temperature blank. °C IR thermometer. <br /> Q oN (3029)930AS <br /> M �r o❑ W _Chilled and placed in cooler with wet ice. Ambient temperature. <br /> 3 lSE9g)daid awau3 <br /> Ambient and placed in cooler with wet Ice. <br /> S % K (809Z8)sysOssCOA Ambient temperature. <br /> Y (easz9)s3pn <br /> O °C Temperature blank. Initial: jaO <br /> w (809Ze)iam-IX319 <br /> 'o $ - 'ecr)Hd.L _ _ = CUSTODY SEAL INTACT: <br /> `4 W (WJ-LOIro(gE0-LOI ro(p)Hdl s! Sample(s): Cooler. No(Not Intact): Not Present: \� <br /> uh (6)Hdl <br /> e e $ Initial: <br /> U - n <br /> ° c m } SAMPLE CONDITION: <br /> y om Yes No WA <br /> Chain-Of-Custody document(s)received with samples........................ <br /> �� S3 A J 8 8 8 ._sem....... ....... <br /> l0 <br /> 329- <br /> a ❑ �$ b s ¢ rc e Samplers name indicated on COC................................................. V . <br /> *- E69 y, r i ` ? Sample container labels)consistent with custody papers........_........... . ....... ...... <br /> 0 E .d M <br /> m (% A N Rc Sample contamer(s)intact and good condition................._............... L/. ....... ....... <br /> V } A <br /> J $ �= 6 N e Correct containers and volume for analyses requested.................. ....... ....... <br /> A a� Proper preservation noted on sample label(s) <br /> nU ❑ Q d w_ r U & VOA vial(s)free of headspace..............__...................................... ...... ...... ✓' <br /> E rc O �_" z o Teeter bag(s)free of condensation. 1" <br /> Gpi w ... <br /> Cp a J a coy Initial: <br /> O $o N 90 e3 <br /> a COMMENTS: <br /> LU <br /> C mo❑ ° <br /> a y 2r <br /> 4) e3 o7. Zr P <br /> ❑o gd r.l 3 �- <br /> yIg e ? Ns0 a j 6 �1 P -g <br /> V �uC :z o.J c�i L9a � m - . OE <br /> y❑ . , o f Q m <br /> IS <br /> W ? <br /> 0. <br /> s o o a <br /> WEl <br /> € <br />