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Page 18 of 18 <br /> WORK ORDER#: F91 El- El ® Ed R1 <br /> rte, tom. Cooler _!_.... of, <br /> SAMPLE RECEIPT FORM ` <br /> CLIEW: C Za1 d\y QiWV=5 DATE: I- <br /> •1�'i��fi <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than Calecience Courier): <br /> Chilled,cooler with temperature blank provided. a 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 /> OC Temperature blank. Initial: � <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler: No(Not Intact): Not Present: J``tt <br /> Initial: W <br /> SAMPLE CONDMON: <br /> You No NIA <br /> Crain-Of-Custody document(s)received with samples.........................„��......., ....... <br /> Sampler's name Indicated on COC................................................ �,....... ....... <br /> Sample container label(a)consistent with custody papers.....................!�...... ....... <br /> Sample contalner(s)Intact and good condition.................................... ....... <br /> Correct containers and volume for analyses requested....................... �....... ....... <br /> Proper preservation noted on sample label(s)..................................... ..... ....;�� <br /> VOA vial(a)free of headspace...............................................I........ ...... <br /> Tedlar hag(s)free of condensation.................................................... .. <br /> lnilial: <br /> COMMENTS: <br />