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Page 67 of 79 <br /> WORK ORDER #: 08 <br /> Inc, Cooler of � <br /> SAMPLE RECEIPT FORM <br /> CLIENT: DATE: f/// <br /> TEMPERATURE — SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY (Other than Caliscience Courier): <br /> Chilled, cooler with temperature blank provided. _ .�°C Temperature blank. <br /> Chilled, cooler without temperature blank. _0C IR thermometer. <br /> Chilled and placed in cooler with wet ice. Ambient temperature (For Air & Filter only). <br /> Ambient and placed in cooler with wet ice. <br /> Ambient temperature (For Air & Filter only). <br /> °C Temperature blank. Initial: <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler: No (Not Intact) : Not Present: <br /> Initial: <br /> SAMPLE CONDITION: <br /> Yes No N/A <br /> Chain-Of-Custody document(s) received with samples......................... ... ... . ... ... . <br /> Sampler's name indicated on COC.................................:......... ... ... . <br /> Sample container label(s) consistent with custody papers..................... ✓ ... ... . <br /> Sample container(s) intact and good condition................................... ... ... . ... ... . <br /> Correct containers and volume for analyses requested....................... <br /> Proper preservation noted on sample label(s)....:.................................. <br /> �... ... . ... .. . . <br /> VOA vial(s)free of headspace. ....................................................... <br /> Tedlar bag(s)free of condensation................................................... t� <br /> Initial: r <br /> COMMENTS: <br /> NW-1 a a (ly 43) tic"+cum v O+ rC W%rc-d,v <br /> �> M-W— I/ , `�{ 7� •lals V✓/ f1C�L �'[SIL0.0� \T� V e <br /> C' 14,1 IDW-I f D rot crce,\r,4 <br />