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MEW <br /> rmri WORK ORDER #. �4 RED <br /> Cooler Of <br /> SAMPLE RECEIPT FORM <br /> CLIENT:.nk _ DATE: <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 /> Ye No NIA <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...............m mm—m—m...... <br /> Correct containers for analyses requested.....m.m.........:....................... ,.. .... <br /> Proper preservation noted on samplelabel(s)........ ........M.M...M............ ... .... ... ... . <br /> VOA vial(s)free of headspace. ....................................................... <br /> Tedlar bag(s) free of condensation...................................... :....s..... <br /> Initial: I.l� <br /> COMMENTS: <br />