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Page 39 of 45 <br /> WORK ORDER #: 08 - ❑� ® _ Q a a a <br /> Cooler 2 of 2-- <br /> SAMPLE RECEIPT FORM <br /> CLIENT: e°Sj h DATE: �31 <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. _ 0 .-�u C 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: t� <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..................... x/ ... ... . ... ... . <br /> Sample container(s) intact and good condition................................... Y ... ... . ... ... . <br /> Correct containers and volume for analyses requested....................... \/ ... ... . ... ... . <br /> Proper preservation noted on sample label(s)..................................... V. ... ... . ... ... . <br /> VOA vial(s)free of headspace. ....................................................... ... ... . ...r.. . <br /> Tedlar bag(s)free of condensation................................................... ... ... . ... ... . <br /> Initial: <br /> COMMENTS: <br />