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TestAmedca MULTI COOLER RECEIPT CHECKLIST <br /> TestAmerica West Sacramento <br /> THE LEADER IN ENVIRONMENTAL TESTING <br /> CLIENT: LOT#(QUANTIMS ID): .b <br /> INITIALS DATE <br /> TEMPERTURE RECORD(IN -C) IR 4 ❑ 5 ❑ OTHER <br /> COOLER ID <br /> CUSTODY SEAL STATUS Z INTACT ❑ BROKEN -p::rw- <br /> CUSTODY SEAL#(S) <br /> COC#(S) 77 <br /> �.� <br /> TEMPERATURE BLANK: OBSERVED:_CORRECTED:_ <br /> SAMPLE TEMPERATURE: <br /> OBSERVED:JZ_-O_&AVERAGE: CORRECTED:_ <br /> SAMPLES/TESTS (IF NCM REQUIRED): <br /> COOLER ID Z-- <br /> CUSTODY SEAL STATUS LaINTACT ❑ BROKEN <br /> CUSTODY SEAL#(S) <br /> COC#(S) <br /> TEMPERATURE BLANK: OBSERVED.- CORRECTED:_ <br /> SAMPLE TEMPERATURE: <br /> OBSERVED: -�-a I ( AVERAGE: to CORRECTED:_ <br /> SAMPLES/TESTS (IF NCM REQUIRED): <br /> 12 O-A <br /> COOLER ID xi, <br /> CUSTODY SEAL STATUS NTACT ❑ BROKEN <br /> CUSTODY SEAL#(S) -q�� 7 <br /> COC#(S) A <br /> OMC <br /> TEMPERATURE BLANK: OBSERVED: CORRECTED: <br /> SAMPLE TEMPERATURE: <br /> OBSERVED:- AVERAGE: ` CORRECTED: <br /> SAMPLES/TESTS (IF NCM REQUIRED): <br /> LEAVE NO SPACES BLANK. USE"N/A"IF NOT APPLICABLE. QA-185 1/D6 DAW, Page 2 <br /> G81050366 TestAmerica West Sacramento(916)373-5600 8 of 31 <br />