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APR-03-2002 18:26 CALSCIENCE P.06i07 <br /> 4 1 <br /> at"-ivnae <br /> nviroezmcrf7t.�+ WORK ORDER UZ FC 31 ® [1 ® E <br /> ettorat�rle�. tr�c. <br /> Cooler Of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: �e DATE: 2L3 <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than Caiscience 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 Applicable(NIA): <br /> Initial: <br /> SAMPLE CONDITION: <br /> Yes No N/A <br /> Chain-Of-Custody document(s)received with samples.......................... `'" .... ..... <br /> Sample container label(s)consistent with custody papers..................... ...,.. .... <br /> Sample container(s)intact and good condition................................... ..... <br /> Correct containers for analyses requested........... ............................. ..... ..... <br /> Proper preservation noted on sample label(s)..................................... ....... ....... �- <br /> VOAvial(s)free of headspace. ... ...................................... ........... ..... „ ...... <br /> Tediar beg(s) free of condensation............. <br /> initial: <br /> COMMENTS: <br />