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ASSOMTED LABORAT O.RIL'S` <br />' (06 North Batavia - Orange, California 92868-1225- 7141771-6900 FAX 714/3381209 <br /> Cooler Receipt Form <br /> Clienti IU <br /> Project `DC— 17 a <br /> Date Cooler Received <br /> Date Cooler Opened. <br /> Was cooler scanned for presence of radioactivity ? Yes/Wo - <br /> If yes was radioactivity results above 25 cpm ? Yes <br /> iWas a shipper's packing slip attached to the cooler '? SINO ~ <br /> If the cooler had custody seal(s),were thy signed and intact? Ye 6No/Na � <br /> Was the cooler packed with Ice <br /> . _Ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> Cooler Temperature: G <br /> *cooler needs to be received @ 4°C with an acceptable range of 2°-6 4C <br /> If samples were hand delivered do they meet the temp criteria, which should be °C with <br />' an acceptable range of 2°- 6 °C ? <br /> ki!S5N o <br /> If no explain. <br /> Were all samples sealed in plastic bags ? <br /> � es NO <br />' Did all samples arrive intact?If no,indicate below. Y o <br /> Were all. samples labeled correctly ?(ID's Dates,Times)If no, indicate below. e fNo <br /> - Can the tests <br /> required be ran with the provided containers, If no indicate below. o <br /> Was sufficient <br /> sample volume sent for all containers ? a <br /> an <br /> Were <br />' Y VOA vials received with head space? Yes/(!q(Na <br /> Was the correct preservatives used (:!(:!!No/Na <br /> If no, see the pH log for a list of samples containers regarding pH v <br /> AnY other important information <br /> Receiving Dep�-tment 91'✓ Date <br />