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Page 35 of 35 <br /> WORK ORDER #: 08a. <br /> Cooler of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: 6e2w�-ec_ DATE: <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 Present.- <br /> Initial: <br /> resent:Initial: <br /> SAMPLE CONDITION: <br /> Yes No N/A <br /> Chain-Of-Custody document(s) received with samples......................... v.-,,. ... ... . ... ... . <br /> Sampler's name indicated on COC................................................. V.,. ... ... . <br /> Sample container label(s) consistent with custody papers..................... Y <br /> Sample container(s) intact and good condition................................... 1 . ... ... . <br /> Correct containers and volume for analyses requested....................... ✓ ... ... . ... ... . <br /> Proper preservation noted on sample label(s)..................................... +/ <br /> VOA vial(s)free of headspace. ....................................................... f <br /> Tedlar bag(s)free of condensation................................................... ... ... . ... ... . Y <br /> Initial: <br /> COMMENTS: <br />