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FEB-20-2003 15:2B CALSC I ENCE EW I RONMENTAL 714 894 7501 P.12 <br /> 5 , <br /> y�,___ <br /> WORK V/•�RDE M. s w 03 EN REN2 9 <br /> Cooler i. - of --I- <br /> SAMPLE RECEIPT FORM <br /> CLIENT: ICLF19 DATE: 09 12w 03 <br /> TEMPERATURE--SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than Calacience CourIO: <br /> Chilled,cooler with tempereture blank pronrlded. S► °C Tempetw#uro blank. <br /> Chilled,cooler without temperature blank. °C IR thefmameter. <br /> Chilled and placed in cooter with wet ice. ambient temperaWre. <br /> Ambient and placed In cooler whh wet ice. <br /> Ambient temperature. <br /> C Temperature blank. Initial. <br /> CUSTODY SEAL INTACT: <br /> -ample(&). Cooler.,,- mo(Not intact): Not Applimble(N/A): <br /> lrsitl8t, <br /> SAMPLE CONDfTION: <br /> Yee No WA <br /> Chain-Of-Cuamciy documen(s)r+ xirred with samples.......... ........ ..... ....... ......_,... <br /> Sample cortt$iner labels)oortslstent with custody papers......... .. ... .._� ,..... ..... <br /> ._� •. . <br /> Sample container(a}Intact and good condition. ... . .. . ....... ..... <br /> LVI rect comers�analyM n�uW11!......... .. ..... ....... .r .r . .......ter. <br /> Proper preservation noted on sample labels) .. . ................. ..........� �........ ....... <br /> VGA vlal(s)free of headspaae. ... ... . ....... ...... ....... . ......... ...... . ......._,,,%e—_ <br /> Tedlar bag(s)flu of condensation . ........................ . ........... .�....,.. �, ,......._�� <br /> InlUal: <br /> COMMENTS: <br />