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10/15/2002 15:50 530297480 KIFF ANALYTICAL JO OCT-11-2002 11:37 CIENCE <br />PAGE 41 <br />, 14 854 7501 <br />P.11/11 <br />Initial: ° C Temperature blank. <br />SAMPLE CONDITION: <br />Yes N9 NIA <br />IIII <br />I CUSTODY SEAL INTACT: <br />Sample(s): _ Cooler; ‘V No (Not Intact): Not Applicable (N/A): <br />Initial: <br />i <br /> Proper preservation noted on sample ladel(s). 0•11••••••••• <br />i.r. <br />VOA vial(s) free of headspace <br />.N.,' <br />Tedlar bag(s) free of condensation ..... MP W. <br />COMMENTS: <br /> ....1•1•••••••• <br />I ni tia i : <br />N.• ..... .. "Wll"Ow............ <br />'%,-- "BO". 1111111.411 <br />N., .11..41" • •• • ••• • <br />\V • ,..,., "•..• <br />II <br />I Chain-Of-Custody document(s)received With samples.„.b.„ ....... ....,..— <br />Sample container label(s) consistent with custody papers <br />Sample container(s) intact and good condition.. <br />Correct containers for analyies requested <br />fYi <br />TEMPERATURE - SAMPLES RECEIVED BY: <br />CALSCIENGE COURIER: LABORATORY (Other than CaIscience Courier): <br /> Chilled, cooler with.temperature blank provided. °C Temperature blank. <br /> Chilled, cooler without temperature blank. °C IR inermcmeter. <br /> Chilled and placed In cooler with wet ice. Ambient temperature. <br />Ambient and placed in cooler with wet ice, <br />Ambient temperature. <br />WORK ORDER it: 02-DU - E <br />Cooler 1 of 1 <br />SAMPLE RECEIPT FORM <br />DATE: L&10/ qa CLIENT: <br />CAscionce <br />Mirvironmental <br />ArwaborBtorlas, Inc. <br />TO-PAL P.11