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Columbia <br /> Analytical 5090 Caterpillar Road <br /> ServiCesi„c Redding,CA 96003 <br /> [AnEmpIoyee-0w..a.------ny <br /> -5262 <br /> COOLER RECEIPT FORM <br /> Project/Client: �[.e � ,, _ /1 Batch No.: <br /> 1. Cooler(s)/Sample(s)received on: 10/7-6/0' Shipped via <br /> Shipping Bill#(s):_101-(Z-7 99 3 9 <br /> #of Coolers/Packages 3 <br /> 2. Radiological Screening by: ,a7Jill /:. �� Acceptable Rejected <br /> 3. Custody seals on outside of cooler: <br /> If yes,where? Front Rear Lt Side YES NO N/A <br /> Rt Side <br /> Seals intact: YES <br /> COOLER/SAMPLE PROCESSING <br /> 4. Sample Processing/Tagging by: <br /> 5. Coolers)/Sample(s)Temp's: S:o P,. <br /> (or) <br /> Temp.Blank(if included): <br /> 6. Type of packing material(circle): Ice lue Ice bble Wrap u le Bag Zip Locks Webbing <br /> Other: <br /> 7. Custody papers properly filled out(ink,signed,dated,released,etc.)? YES NO <br /> 8. Containers arrived in good condition(not broken,leaking,etc.)? YE NO <br /> 9. Samples received with adequate holding time remaining to conduct analysis? NO <br /> 10. Container labels complete(i.e.analysis,preservation,date/time,etc.)? <br /> NO <br /> 11. Container labels and tags agree with custody papers? NO <br /> 12. Correct types of containers used for the tests indicated? 9 <br /> NO <br /> ' a.) Adequate sample received? If not,note on Exception Report. NO <br /> 13. Containers supplied by: <br /> A Other <br /> 14. Preserved containers received with the appropriate preservative? <br /> `� S NO N/A <br /> pR' ----s1/ � (or) See pH log. <br /> 15. VOA vials free of air bubbles?. YES NON/A <br /> 16. Trip.Blank preparation date: <br /> CAS Othe N/A <br /> 17. Volatile Soil samples: Encores or Plugs in Vials <br /> ' Freezer or GCIMS Date: Time: N/A <br /> See Exception Report for discrepancies. <br /> Rev.8/t8/2004/ds <br /> 39 <br /> 9 <br />