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4AI <br /> ASSOCIATED LAHORA TOMES <br /> 806 North Batavia- Orange, California 928681225- 714/771-6900 FAX 714/5381209 <br /> Cooler Receipt Form <br /> Client- - Project 17 Z <br /> Ll <br /> Date Cooler Received. _ -- �-1 Date Cooler Opened: 1 4 - 14 <br /> - <br /> Was cooler scanned for presence of radioactivity ? YeS/Va <br /> If yes was radioactivity results above 25 cpm 7 Ye o <br /> Was a shipper's packing slip attached to the cooler ? (fe�/No <br /> If the cooler had custody seal(s),were thy signed and intact 7Ye /No/Na <br /> Was the cooler packed with- Ice �ce Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> a <br /> Cooler Temperature: 3- fly * <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 critena, which should be @ 4°C with <br /> an acceptable range of 2°- 6 °C 9 es o <br /> If no explain <br /> Were all samples sealed in plastic bags 9so <br /> Did all samples arrive intact ?If no, indicate below es o <br /> Were all samples labeled correctly ? (ID's Dates, Tunes) If no, indicate below, es a <br /> Can the tests required be ran with the provided containers, If no indicate below. es o <br /> Was sufficient sample volume sent for all containers ? Yes/No <br /> Were any VOA vials received with head space ? Ye oNa <br /> Was the correct preservatives used ? 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 1''! Date A° <br />