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rKli <br /> + "�o WORK ORDER#: 02P-Efl D - I W 519 <br /> Cooler of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: Kt FI✓ DATE: !„Q$�d-,A.- <br /> TEMPERATURE-SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Odw r than Calsalence Courier): <br /> Chilled, cooler with temperature blank PVVWed. 3_15 C Temper an blanc. <br /> Cr Nled,Cooler without Wmp mbn blank *C IR thWmWwter. <br /> Chated wW placed In cooler with wet ice, Ambient temperature. <br /> Ambler and placed In cooler vvlth wet kap. <br /> Ambient temperature. <br /> °C Tempmtcre blank. lrtit#8t <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler No(Nat intact): Not Appikmble(1WA): <br /> In <br /> SAMPLE CONDITION: <br /> Yes No WA <br /> ChakWX-C,ustody downwgs)reeshmd with sawvl es......................... .... <br /> SamPie container labet(s)consistent with carat W papers..... ........ .......��c/ ....... ......---_ <br /> Sample container(s)intact and goo cor4Itjon .............. .... <br /> CoffWcontsinemfor anai ws m. u .........../..//►...................... ..... <br /> Proper Pr -orlon noted on sample label(s)......:.. ... ........ . ... .... ... . <br /> VOA%Ws)*m of headspaoe................... ... ... ...................... . .,.. <br /> Tedlarl�g(s)fir+0a of c:crrd�.... .......... .... ...... .. . ..,.............. _...... ...,... <br /> Ir�tlak <br /> i <br /> COMMENTS: <br />