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ASSOCIATED LABORATORIES <br /> 6 North Batavia- orange, California 92868-1225- 7141771-6900 FAX 7141538-1209 <br /> Cooler ReedIP t Form <br />' Client <br /> Project. TU C_ 17 <br /> Date Cooler Received: __ 'L�23� Date Cooler Opened: 2—�"3 -- s <br /> Was cooler scanned for presence of radioacdvity? Ye <br /> vilc <br /> If yes was radioactivity results above 25 cpm ? Y o <br />' was a shipper's packing slip attached to the cooler? y o <br /> If the cooler had custody seal(s), were thy signed and intact? -Y o/Na <br /> j� . <br />' Was the cooler packed with: Ice ✓ Ice Packs Bubble <br /> wrap Styrofoam Paper None Other <br /> Cooler Temperature: I - ?--- <br /> *cooler <br /> *cooler needs to be received @ 4°C with an acceptable range of 2°- 6 IC <br /> If samples were hand delivered do the meet the tem <br /> Y e p.criteria,which should be 40C wifh <br /> an ptable range of 2 6 °C ? o <br /> If no explain. <br />' Were all samples sealed in plastic bags ? (fe�No <br /> Did all samples arrive intact?If no, indicate below (5 No <br />' Were all samples p labeled correctly? (IDs Dates,Times)If no,indicate below. QeslNo <br />' . Can the tests required be ran wrth the provided containers, If no indicate below. Yes/No <br />' Was sufficient sample volume sent for all containers ? (e N o <br /> Were any VOA vials received with head space ? ye�} a <br /> Was the correct preservatives used? e o/Na <br /> If no,see the pH log for a list of samples containers regarding pH `� <br /> A­nY other important information <br /> Receiving Department -Date 2/ 23/ k <br /> 1 <br />