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IL1 <br /> 1M\ A.ssacn LAsorrAToxrEs <br /> ONorth Batavia-Orange, California 928681225- 7141771-6900 FAX 71415381209 <br /> Cooler Receipt Form <br /> Client Project• L 17 9 <br /> Date Cooler Received: 12 o S Date Cooler Opened. _ 12-7/05- <br /> Was <br /> Z7/05-Was cooler scanned for presence of radioactivity ?' Ye5/T `If yes was radioactivity results above 25 cpm 7 Ye o <br /> Was a shipper's packing slip attached to the cooler? CDNO <br /> 1 <br /> If the cooler had custody seals),were thy signed and intact? �o/Na <br />' Was the cooler packed with- Ice Ice Packs Bubble wrap <br /> Styrofoam Papez None Other <br /> Cooler Temperature: 2- - 6 C <br /> *cooler needs to be received @ 4°C with an acceptable range of 2°-6 °C <br /> yIf samples were hand delivered do they meet the temp criteria,which should be @ 4°C with <br /> an acceptable range of 2"- 6 °C ? V'OSINo <br />' If no explain <br /> Were all samples sealed in plastic bags ? Yes/No <br /> Did all samples arrive intact?If no, indicate below Ye o <br /> Were all samples labeled correctly ' If no indicate below Ye /No <br /> P y ? (IDs Dates Times) <br />' Can,the tests required be ran with the provided containers,If no indicate below. (:Ye'JNo <br /> Was sufficient sample volume sent for all containers 7 (DY s/No <br /> Were any VOA vials received with head space ? Yes VTo?Na <br /> Was the correct preservatives used Y o/Na <br /> If no, see the pH log for a list of samples containers regarding H <br /> P g gp <br />' Any other important information <br /> Receiving Department. Date <br />