Laserfiche WebLink
1 <br /> ralbl=t=rttvavl� fes, WORK ORDER #: 03-® ® - ® M [g-1 <br /> - Cooler .�_ of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: P DATE: 3lD 3 <br /> TEMPERATURE — SAMPLES RECEIVED BY— <br /> CAI-SCIENCE COURIER: LABORATORY (Other than Calscience Courier): <br /> Chilled, cooler with temperature blank provided _C�- °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 cooler with wet ice <br /> Ambient temperature <br /> °C Temperature blank initial <br /> CUSTODY SEAL IN <br /> Samples} Cooler ✓ No (Not Intact) Not Applicable(NIA) <br /> Initial <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chain-Of-Custody documen (s) received with samples r <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) �T <br /> VOA vial(s) free of headspace <br /> Tedlar bag(s)free of condensation _ <br /> Initial �- <br /> COMMENTS: <br />