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AkASS 0CIA TED LAB ORA TOMES <br />' 806 North Batavia - Orange, California 92868-1225- 7141771-6900 FAX 7141538-1209 <br />' Cooler Receipt Form <br /> Client k-X C- Project T-p 2- <br />' � P <br /> Date Cooler Received _ 19 Dat„ Cooler Opened. _ S1 f <br /> Was cooler scanned for,presence of radioactivity ? Yes o <br /> If yes was radioactivity results above 25 cpm ? Yes o <br /> Was a shipper's packing slip attached to the cooler Ye /No <br /> If the cooler had custody seal(s),were thy signed and intact ? es' o/Na <br /> Was the cooler packed with Ice -x ice Packs Bubble wrap <br />' Styrofoam Paper r None Other <br /> Cooler Temoerature 3 9 <br /> *-cooler needs to be received cr 4°C with ani acceptable range of 2°- 6 °C <br /> If samples were hand delivered do they meet�.he-temp criteria, which should b: tes/ c <br /> with <br />' an acceptable range of 2°- 6 °C ? 0 <br /> If no explain <br />' <br /> Were all samples sealed in plastic bags 9 YN0 <br />' Did all samples arrive intact ?If no, indicate below es/No <br /> Were all samples labeled correctly ? (ID's Dates, Tunes) If no, indicate below Yes/No <br /> 1 <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 ? (f!YNo <br />' Were any VOA vials received with head space? Yes/l`do a <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 5 1 <br />