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ASSOCIATED LABORATORIES <br /> 806 North.Batavia-Orange, California 92868-1225- 7141771-6900 FAX 7141538-1209 <br />` Cooler Receipt Form <br /> Client D C Project. <br /> Date Cooler Received. Date Cooler Opened. < 110 <br /> Was cooler scanned forresence of radioactive ? Ye <br /> If yes was radioactivity results above 25 cpm ?y Ye� <br /> Was a shipper's paclflng slip attached to the cooler? Y�1No <br />' If the cooler had custody seal(s),were thy signed and intact? Y } oiNa <br /> Was the cooler packed with.Ice , Ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> n <br /> Cooler Temperature- 2- -L �-- <br /> *cooler needs to be received @ 4°C with an acceptable range of 2°-6°C <br /> If samples were hand dehvered do they meet the temp.criteria,which should be °C with <br /> an acceptable range of 2°- 6 °C ? Ye o <br /> If no explain: <br /> Were all samples sealed in plastic bags? Yes No <br /> ' Did all samples arrive intact?If no,indicate below. YeslNo <br /> Were all samples labeled correctly ? (ID's Dates, Times)If no, indicate below (Ye INo <br /> 1 <br /> Can the tests required be ran with the provided contaemrs, If no indicate below. (?NO <br /> Was sufficient sample volume sent for all containers ? Yes(No <br /> Were any VOA vials received with head space? Yes�l�a <br /> Was the correct preservatives used? es/No�Na <br /> If no, see the pH log for a lest of samples containers regarding pH <br /> • Any other important information <br /> I <br /> Receiving Department Date <br />