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Page 8 of 8 <br /> El F-01 <br /> Y��r hmr- <br /> ORDER #: 05 - r a a aWORK <br /> COOI@I' t Of <br /> SAMPLE RECEIPT FORM <br /> CLIENT- -��� A,����-'�'ZC-I��- DATE: <br /> TEMPERATURE — SAMPLES RECEIVED BY• <br /> CALSCIENCE COURIER- LABORATORY (Other than Calscience Courier) <br /> Chilled, 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 cooler with wet ice <br /> Ambient temperature <br /> °C Temperature blank Initial <br /> CUSTODY SEAL INTACT: <br /> Sample(s) Cooler. No (Not Intact) Not Applicable (NIA) <br /> • Initial <br /> SAMPLE CONDITION: <br /> Yes No NIA <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 />