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ASSOCL47ED LABORA TOMES <br /> 806 North Batavia-Orange, California 92868-1225- 7.141771-6900 FAX 71415381209 <br /> Cooler Receipt Form <br /> Clientqlax: Project: G t72-- <br /> Date <br /> 72 -Date Cooler Received: Date Cooler Opened. I I —'f <br /> Was cooler scanned for presence of radioactivity ? ye <br /> If yes was radioactivity results above 25 cpm ? ye o <br /> Was a shipper's packing slip attached to the cooler ? <br /> If the cooler had custody seal(s),were thy signed and intact? Q!!7o/.IIa <br /> Was the cooler packed with: Ice 2—z— Ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> D <br /> Cooler Temperature: Z 7 C/ x <br /> • *cooler needs to be received @ 4°C with an acceptable range of 2°- 6 °C <br /> If samples were hand delivered do they meet the temp cnteria, which should be 4°C with <br /> an acceptable range of 2°- 6 'C 9 Yes/No <br /> If no explain <br /> Were all samples sealed in plastic bags 7 es 40 <br /> Did all samples arrive intact?If no, indicate below (ye o <br /> Were all samples labeled correctly ? (ID's Dates, Times) If no, indicate below Ye o <br /> Can the tests required be ran with the provided containers, If no indicate belowYes/No <br /> Was sufficient sample volume sent:for all containers ? Yes/No <br /> Were any VOA vials received with head space ? YesA&oa <br /> Was the correct preservatives used ? es o/Na <br /> If no, see the pH log for a list of samples containers regarding pH <br /> Any other important information. <br /> Receiving Department. Date �l <br />