Laserfiche WebLink
WORK ORDER #: ED]® =`FkI- ff]' Fol©®® <br /> Cooler k of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: DATE: <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than Calscience Courier): <br /> Chilled, cooler with temperature blank provided. 3 °C Temperature 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 /> Ambient temperature. <br /> °C Temperature blank. Initial: W� <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler: . No (Not Intact) : Not Applicable (N/A): <br /> Initial: WV <br /> SAMPLE CONDITION: <br /> Yes No N/A <br /> Chain-Of-Custody document(s)received with samples......................... / ... .... .... <br /> Sample container label(s)consistent with custody papers..................... �� ... .... ... .... <br /> Sample container(s)intact and good condition................:.................. / ....... ... .... <br /> Correct containers 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 /> Initial: <br /> COMMENTS: <br />