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ASSOCMTED L BoRATORLES <br /> North Batavia-Or4ngev California 92568-1225- 7141771-6900 FAX 71415381209 <br /> Cooler Receipt Form <br /> Client: - - 7 --4► Ptoject: TV C 1 -7 <br /> i <br /> Date Cooler Received: Date Cooler Opened: <br /> Was cooler scanned for presence of radioactivity? Yes/I�Y�i <br /> � <br /> If Yes was radioactivity results above 25 cpm? Yeo <br /> Was a shipper's packing slip attached to the cooler? Ye 0 <br /> If the cooler bad custody seal(s),were thy signed and intact? Yes/No/ CEL 1.,F <br /> Was the cooler packed with:lee ZIce Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> v <br /> Cooler Temperature: . <br /> *cooler needs to be received @ 4°C with an acceptable range of 20-6 °C <br /> If les were land delivered do they meet e <br /> �P ey the temp.criteria,winch should be @ 40C with <br /> an acceptable range of 21- 6°C ? eSNo <br /> If no explain: <br /> Were all samples sealed in plastic bags? e O <br /> Did all samples arrive intact?If no,indicate below. les�'No <br /> Were all samples labeled correctly?(ID's Dales,Times)If no, indicate below. &NTO <br /> Can the tests required be ran with the provided containers,if no indicate below. Yes�/No <br /> Was sufficient sample volume sent for all containers ? &o, <br /> Were any VOA vials received with head space? Yesl�Na <br /> Was the correct preservatives used? �vv/Na <br /> If no, see the pH log for a list of samples containers regarding pH <br /> Any other important information: <br /> Receiving Department �� Date: <br />