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MRR-13-2W3 11 45 CRI-SCIENCE ENV I RON101, RL 714 894 7501 P.05/06 <br /> f . WORK ORDER#: 010 ® - A ® ® E <br /> Cooler of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: S DATE: 3 ! a 3 <br /> TEMPERATURE —SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than Calselance Courier): <br /> ChRled,cooler with temperature blank provided ,T °C Temperature blank <br /> ChRled, cooler without terripwature blank °C IR thermometer. <br /> Chilled and placed In copier with wet Ice Amblent temperature <br /> Ambient and placed In copier with wet ice <br /> Ambient temperature <br /> °C TemP ersturo blank Initial <br /> CUSTODY SEAL INTACT: <br /> sample(s) Coolor / No(Not Intact)• Not Applicablo(NIA)- <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Cham-Of-Custody document(s)received with samples r <br /> Sample container label(s)consistent with custody lapem <br /> Sample container(s)intact and good condition . .,. .. <br /> Comoc t containers for analyses requested .. ... <br /> Proper preservabon noted on sample label(s) �T <br /> VOA vial(s)free of headspaca <br /> Tedli:ir beg(s)free of condensation. .,.. <br /> lnrtial �,,, <br /> COMMENTS: <br />