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ASSOC ATED LAB o.RAromrES <br /> 6 North Batavia-orange, California 92868-1225- 7141771-6900 FAX 714/538-.1209 <br /> Cooler Receipt Form <br /> Client. Project. i UC- ) -3 2-- <br /> Date Cooler Received: If - 4 =� Date Cooler -- <br /> Opened: <br /> Was cooler scanned for presence-of radioactivity ? <br /> If yes was radioactivity results above 25 cpm ? YYe <br /> o <br /> Was a shipper's packing slip attached to the cooler? Y <br /> es/1t7 <br /> If the cooler had custody seal(s),were thy signed and intact? <br /> - (-- o)Na <br /> Was the cooler packed with: lee ' .Ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> — . <br /> 0 <br /> Cooler Temperature- L{ 2-- C--* <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. criteria, which should be 40C with <br /> as acceptable range of 2°-6 °C '� @ <br /> e!To <br /> If no explain. -- <br /> Were all samples sealed in plastic bags ? <br /> o <br /> Did all samples arrive intact ?If no, indicate below. <br /> �o <br /> Were all samples labeled correctly ? (ID's Dates, Tunes)If no, indicate below. es�TTo <br /> Can the tests required be ran <br /> ! with the provided containers, If no indicate below. o <br /> Was sufficient sample volume sent for all containers ? <br /> Were any VOA vials received with head space 7 <br /> 'es/N`' <br /> o/Na <br /> Was the correct preservatives used <br /> If no, see the pH log for a list of samples containers regarding pHes�IrTo/Na <br /> Any other important information- <br /> Receiving Department Date- /I— i <br />