Laserfiche WebLink
Page 7 of 7 <br /> a_1�ctence <br /> R1 - FCJ <br /> pTvIro,ri►ner�ta! (�, <br /> ebdrstarizs. Inc_ WORK ORDER #: 05 (�1W LA <br /> Cooler of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: 4 -� 1 C_4 DATE:'fl�( <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.-11- <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler: No (Not Intact) : Not Applicable(N/A): <br /> Initial: <br /> SAMPLE CONDITION: <br /> Yes No N/A <br /> Chain-Of-Custody document(s) received with samples.............. <br /> amples.............. // ... ... . <br /> Sample container label(s) consistent with custody papers..................... <br /> ... .... ... ... . <br /> Sample container(s) intact and good condition................................... <br /> ... ... . ... ... . <br /> Correct containers for analyses requested......................................... <br /> Proper preservation noted on sample label(s)........................ <br /> VOA vial(s)free of headspace. ................................................ . <br /> . .... ... .... ... ... . <br /> Tedlar bag(s)free of condensation................................ <br /> Initial: Yy <br /> COMMENTS: <br />