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Page 18 of 18 <br /> . WORK ORDER#: 08 - EN- EINFIRI <br /> aborstodoso Cooler of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: ��' ` �V DATE: <br /> F <br /> ATURE--SAMPLES RECEIVED BY: <br /> NCE COURIER: LABORATORY(Other than Calscience Courier): <br /> hilled,cooler with temperature blank provided. ___°C Temperature blank. <br /> Chilled,cooler without temperature blank. l �j:.�°C IR thermometer. <br /> Chilled and placed In cooler with wet ice. _... _Ambient temperature(For Air&Filter only). <br /> Ambient and placed In cooler with wet lee. <br /> Amb nt temperature(For Air$Filter only). ' <br /> °C emperature blank. Initial: I <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler: No(Not Intact): Not Present; <br /> Initial: W� <br /> I <br /> FSAMPLECONDITION: <br /> Yes No NIA <br /> ustody documents)received with samples........................ .. .... ....... <br /> 71 <br /> ameindicated on COC....:............................................ . �....... ....... <br /> Sample container label(s)consistent with custody papers..................... ....... •:••.. <br /> Sample container(s)Intact and good condition................................... ...... <br /> Correct containers and volume for analyses requested.........I............. ��......` ..... <br /> Proper preservation noted on sample label(s)..................................... .....,. <br /> VOAvial(s)free of headspace........................................................ ....... .......� <br /> Tedlar bag(s)flee of condensation.................................................. .... .....� <br /> Initial: <br /> COMMENTS: <br /> i <br />