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h <br /> t <br /> ASSOCIATED LAB ORA TOMES <br /> 806 North Batavia-Orange, California 92968-1225- 7141771-6900 FAX 714IS381209 <br /> Cooler Receipt Form <br /> Client. , Project –I---C: 17 �— <br /> Date Cooler Received: 71 L- Date Cooler Opened. 7l G f <br /> Was cooler scanned for presence of radioactivity ? yee&W' <br /> If yes was radioactivity results above 25 cpm ? y <br /> Was a shipper's packing shp attached to the cooler? eONo <br /> If the cooler had custody seal(s),were thy signed and intact? YM/Na <br /> Was the cooler packed with: Ice lice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> Cooler Temperature- <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 4°C with <br /> an acceptable range of 2°- 6 °C ? yo <br /> If no explain: <br /> Were all samples sealed in plastic bags Y4NO <br /> Did all samples arrive intact?If no, indicate below. S o <br /> Were all samples labeled correctly ? (ID's Dates, Tunes)If no,indicate below C!s/No <br /> Can the tests required be ran with the provided containers, If no indicate below. �`slNo <br /> Was sufficient sample volume sent for all containers ? yea <br /> Were any VOA vials received with head spm? Yes/ZEgNa <br /> Was the correct preservatives used ? �/No/Na <br /> If no, see the pH log for a list of samples containers regarding pH <br /> Any other important info-matzon: <br /> Re_eill-mg Departrnent rnl� Date 711. <br />