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0 <br /> WORK ORDER 1�e 6 a- P ! <br /> C®®ler t Of .�._ <br /> SAMPLE RECEIPT FORM <br /> [C(� DATE: <br /> 2 s a3 <br /> CLIENT: <br /> TEMPERATURE — SAMPLES RECEIVED BY: <br /> CALSCiENCE COURIER' LABORATORY (Other than Calscience Courier): <br /> _ `I C Temperature blank <br /> Chilled, cooler with temperature blank provided °C IR thermometer <br /> Chilled, cooler without temperature blank Ambient temperature <br /> ^� Chilled and placed in cooler with wet ice _ <br /> Ambient and placed in cooler with wet ice <br /> Ambient temperature <br /> Initial <br /> ° —CE4— <br /> C Temperature blank <br /> CUSTODY SEAL. INTACT: <br /> 5ampie(s) <br /> Cooler L/ No (Not Intact) _ Not Applicable (NIA} <br /> ---- <br /> Initial <br /> SAMPLE CONDITION: Yes No NIA <br /> r <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 <br /> Correct containers for analyses requested <br /> Proper preservation noted on sample label(s) —� <br /> VOA vial(s)free of headspace <br /> Tedlar bag(s) free of condensation <br /> Initial <br /> COMMENTS: <br />