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MOV--21--2002 1042 CALSCIENCE 714 894 7501 P.15/18 <br /> WORK ORDER #: 02-ffl 0 - 9 ® 51 U <br /> , <br /> Cooler „� of <br /> SAMPLE RECEIPT FORM <br /> CLIENT:__ )FF DATE: AN, IZ <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other then Caleclence Courle": <br /> Chided,cooler with tempstehv a blank provided. °C Tempersturo blank <br /> Chilled,cooler wllhout temperati+re blank. °C IR thermometer <br /> _Chilled and pleoed In cooler with wet lee Ambient temperature <br /> MOW and pieced in 000ler wfth wet toe. <br /> Amttrent temperature. - <br /> ,�°C Temper re blank. Irliti . <br /> CUSTODY BEAT.INTACT: <br /> sample(s): _ coder. fL No(Not Infect)• Not Applicable(NIA). <br /> InkEal. �L <br /> SAMPLE CONDITION: <br /> Yes ....... No ....... NIA <br /> Chvhi-Of- u*b*dorrument(s)reeved wkh sarnples .... _ .. . ... . . 14 <br /> Sample container Iabel(s)consist with custody papers........... —�r–..-- .. <br /> .........— ....... <br /> Sample containers)iniad and goof c mditlon.............. .......... ....... . . ....... <br /> Correct containers for 8natysee requesfsd..... . ... ..... .... ... . ..... .,..... ...... <br /> PmW preeervftn noted err sample lebel(s}............... .... . . .. ..... ...... ...... <br /> VOAvMs)!roe of heedapsom. ................................ . .... .. .. . ....... .. .... ✓ <br /> Tedlar beg(s)tree of condensation,....,,. .... ........ ... - - - ........ ... .... <br /> Initiak N <br /> COMMENTS: <br />