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APR-03-2002 IS 26 CALSCIENCE P•06/07 <br /> .rnvirortrrraAtal WORK ORDER #: 0242 [N - 0 [2 <br /> �..eboY�larlss- !nc_ <br /> Cooler I Of <br /> SAMPLE RECEIPT FORM <br /> CLIENT:, i'r DATE: 3 U c�'� <br /> FTEMPERATURE — 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 °C IR thermometer_ <br /> Chilled and placed in cooler with wet ice �� Ambient temperature <br /> Ambient and placed in cooter with wet ice <br /> Ambient temperature <br /> C Temperature blank Initial <br /> - <br /> CUSTODYNTACT: <br /> Sample(a) Cooler _ No (Not intact) Not Applicable(NIA) <br /> initial <br /> SAMPLE CONDITION: Yes No N/A <br /> Chain-Of-Custody document(s)received with samples ..,. `�^•.•• •- <br /> Sample container tabel(s)consistent with custody papers - <br /> Sample container(s)intact and good condition ��' •• ,,, <br /> Correct containers for analyses requested --�— . ••. <br /> Proper preservation noted on sample label(s) ., ..•.... <br /> VOA vial(s)free of heabspace <br /> �4 <br /> Tedler bag(s) free of condensation . . •• •- <br /> initial_ <br /> COMMENTS: <br />