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PPR-14-2003 12 15 P.015/07 <br /> WORK ORDER#: 03.0 2 - R 10 W El <br /> Cooler I of <br /> SAMPLE RECEIPT FORM <br /> CLIENT:-.ir- pf-' _-- DATE. • <br /> FCALSCIEINCE <br /> ATURE SAMPLES RECEIVED BY: <br /> COURIER: LABORATORY(Other than Cakcience Courier): <br /> hilled,cooler with temperature blank provided. 'C Temperature blank. <br /> Chilled,cooler witttoul temperature blank. °C IR ihermortKftr <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 /> Semple(s). Cooler. Z No(Not Intact) Not Applicable (NIA), <br /> Inibel: <br /> SAMPLE CONDrrION: <br /> Ye► No WA <br /> Chain-Of-Custody documents)received with samples , .... . �.~. .... •.. ... <br /> sample container label(a)consistent with custody papers .... ..... <br /> Sample container(s)intact and good condman <br /> Correct containers for analyses requested .... . �.... . .. . <br /> Proper preservation noted on sample label(s) <br /> VOA vial(s)free of headspace_ <br /> Tediar bag(s)free of condensation <br /> Initleh <br /> COMMENTS: <br />