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7Cr"-Y_!-]-cvm� i 1•tJ Lt-+L�.�uv�.t r 1�f t3`J4 15F71 Y IObli�s <br /> ernes � <br /> WORK ORDER* O2-Fol Q - F11 D El ID <br /> isbors►rorfsw.�r�a. <br /> Cooler of_ <br /> SAMPLE RECEIPT FORM <br /> CLIENT: <br /> DATE: kIz <br /> TEMPERATURE--3 LES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than CsisohmcO Courter): <br /> __ Chilled, cooW w�h temperature blank provldod. "C Temperature blank. <br /> Chilled,cooler wyftut temperature blank _ DC IR thernwrneW. <br /> Chilled and placed in cooler with wet Mme. _^Ambient tempemtu% <br /> Ambient and placed in cooler with wet ice. <br /> Ambient temperature. <br /> °C Tempsrat«re blank <br /> InWah <br /> CUSTODY SEAL INTACT: <br /> 5ample(S). Cooler_ No(Not tnta , Not AppGCeblB(NIA): <br /> Initiak <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chau-Of-Custody daUment(s)received wfth samples. . ... ......... . �;...... ,.•,,••r., <br /> Sample ciontalner labels)consistent wkh V410dy Papers- ----- - --------- ✓ ... .._. .,.......... <br /> Sample containers)intact and good condition. . .. . ...... .. ...... �/ ... ...._.^. <br /> Correct containers for analyses requested.... . .. ... . . ............. �....... ........ <br /> Proper preservation noted on sample label(s) ...... . ... . .... . . .. ..... . Z;71�....... ....... - <br /> VOAvtags)free of headspam .......... ........................... . . . ... .... ......, ...... <br /> Tedlar bag(a)free of condensation . . .. .................................... . ....... ..... ��- <br /> WWI: <br /> COMMENTS: <br /> T[]Tf)L P.06 <br />