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Y <br /> ASSOCIATED LABORATORIES <br /> 8 orth Batavia-Orange, California 92868-12.25- 7141771-6900 FAX 714/538-1209 <br /> Cooler Receipt Form <br /> Client. -T Project: TVC. 2— <br /> U 0 <br /> Date Cooler Received. f �i ��- Date Cooler Opened. <br /> Was cooler scanned for presence of radioactivity ? Yes <br /> If yes was radioactivity results above 25 cpm ? Yes1k1,0 <br /> Was a shipper's packing slip attached to the cooler? Yes,�T <br /> If the cooler had custody seal(s),were thy signed and intact Yes/No/Na <br /> Was the cooler packed with Ice 1--l" Ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> Cooler Temperature 3-5 C, <br /> *cooler needs to be received @ 4°C wrath an acceptable range of 20-6 °C <br /> If samples were hand delivered do they meet the temp cnteAa,which should be @ 4°C with <br /> an acceptable range of 2°- 6 'C ? <br /> If no explain. <br /> Were all samples sealed in plastic bags ? (Ces/No <br /> Did all samples arrive intact?If no, indicate below Yes/No <br /> Were all samples labeled correctly '? (ID's Dates, Tunes) If no,indicate below Yes/No <br /> Can the tests required be ran with the provided containers, If no indicate below. Ye o <br /> Was sufficient sample volume sent for all containers ? Yes/No <br /> Were any VOA vials received with head space ? YesJQo/Na <br /> Was the correct preservatives used 9Y�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 f>`✓ Date <br />