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0612412003 17:20 5302974608 KIFF ANALYTICAL PAGE 14 <br /> ��nW WORK ORDER #: 03 <br /> orlrs. Mc. <br /> CoolerI of L,,_ <br /> SAMPLE RECEIPT FORM <br /> CLIENT:_ VL.1� _ DATE' -L12'ef, 3 <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than Calscience Courier): <br /> Chilled, cooler with temperature blank provided. °C Temperature blank. <br /> Chilled, cooler without temperature blank. °C IR thermometer. <br /> Chilled and placed in cooler with wet ice. Ambient temperature. <br /> Ambient and placed in cooler with wet ice. <br /> Ambient temperature. <br /> C Temperature blank. Initial: <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler._ No(Not Intact) : Not Applicable(NIA): <br /> Initial: <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chain-Of-Custody document(s) received with samples......................... <br /> Sample container label(s) consistent with custody papers..................... _ . .. .... <br /> Sample container(s)intact and good condition............ ................ �I/... ... . <br /> Correct containers for analyses requested......................................... �k/ ... .... <br /> Proper preservation noted on sample label(s)..................................... ... .... <br /> VOA vial(s)free of headspace. ............. .......... . ............................ .. .... <br /> Tedlar bag(s)free of condensation................................................... ... ... . <br /> Initial: <br /> COMMENTS: <br />