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ASSOMTED LAB <br /> 806 North Batavia- Orange, California 92868122,E- 7141771-6900 FAX 7141538-1209- <br /> Cooler <br /> 14/538-.1209Cooler Receipt Form <br /> 1 ` <br /> -client � Prod ect- <br />' Date Cooler Received: Date Cooler Opened: <br /> Was cooler scanned for presence of radioactivity? ca o <br /> If yes was radioactivity results above 25 cpm ? o <br /> Was a shipper's packing slip attached to the cooler? o <br /> If the cooler had custody seal(s),were thy signed and intact? Y 6/Na <br /> Was the cooler packed with- Ice Ice 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 20- 6 OC ? Yes/No <br /> If no explain: <br />' Were all samples sealed in plastic bags ? Yes/No <br /> Did all samples arrive intact?If no, indicate below Yes/No <br /> Were all samples labeled correctly ?(ID's Dates,Tunes) If no, indicate below. Yes/No <br />' Can the tests required be ran with the provided containers, If no indicate below. Yes/No <br /> Was sufficient sample volume sent for all containers '? Yes/No <br /> Were any VOA vials received with head space Yes/No/Na <br /> Was the correct preservatives used? Yes/No/Na <br /> If no, see the pH log for a list of samples containers regarding pH <br /> Any other important information <br />' Receiving De <br /> a pariment Date: L.LK <br />