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Y <br /> ASS 0CMTED LAB ORA TOPJES <br /> 806 North Batavia - Orange, California 92868-1225- 714/771-6900 FAX 7141538.1209 <br /> Cooler Receipt Form <br /> Client tel'- - t�- _ Project <br /> Date Cooler Received: Date Cooler Opened: <br /> Was cooler scanned for presence of radioactivity 9 YesQ <br /> If yes was radioactivity results above 25 cpm ? Yes/No <br /> Was a shipper's packing slip attached to the cooler? YeVIL) <br /> If the cooler had custody seal(s),were thy signed and intact? Yes/Nola <br /> Was the cooler packed with Ice A— Ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> Cooler Temperature t- <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 c@ 4°C with <br /> an acceptable range of 2°- 6 °C 9 Yes/No <br /> If no explain: <br /> Were all samples sealed in plastic bags ? 6!T40 <br /> Did all samples arrive intact?If no,mchcate below CYeYNO <br /> Were all samples labeled correctly?(ID's Dates, Tunes)If no,indicate below. /!�5o <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 ? (9va <br /> Were any VOA vials received with head space? Yes��Na <br /> Was the correct preservatives used 9 Yes/Noea <br /> If no, see the pH log for a list of samples containers regarding pH <br /> iAny other unportant information <br /> Receiving Depart ment __- ----"�'--- Date a"Oc _ - - <br />