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JR4-03 2M 09:35 GUCIENCE 724 894 '7501 P.09/18 <br /> AVIL.is-I--- ► <br /> n+rwG"►r,...ar WORK ORDER#:� rlil ®- Efl 91 alff Cooler 1 of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: !r DATE: <br /> TEMPERATURE--SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER; LABORATORY(Ol ter than COwlenoe Courier): <br /> ChAied,cooler with temperetwe Wank provided. °C Tonveratwe blank. <br /> Ch sled,cooler without temperature blank "C IR thermometer <br /> Chliled and placed In cooler with wet ice. Ambient temperature, <br /> Ambient and placid In cooler with wet ice <br /> Arnblent temperature <br /> °C Temperature blank InkM <br /> CUSTODY.45 INTACT: <br /> S ple(s) Cooler No(Not Intact) Not ApplicalNe(wAx <br /> tnitiat: <br /> SAMPLE CONDITION: <br /> Yes No WA <br /> C113ln-0f Custody doc imant(s]received with samplds..... .. . . .. . . �]G_... ... ....... <br /> Sample corrtalrrar Ia*l(s)consistent with custody papers .„yam r_............... <br /> Sample containers)Intact and good ar ditian. ... .. ... . .. �`....... ,....�. <br /> Correct g <br /> containers fbr ansiysesreaves tod . .. .. ,. ....... ....... <br /> Proper preservation noted on wwn a labol(s) ....... .... . .. . . .......... . �..• <br /> VOA vlal(s)free of headepaee. ..... . . . . .... .. . �� <br /> ....... ....... <br /> Tediar bags)tree of Condensption. .. ...... ... <br /> Initlal: <br /> COMMENTS: <br /> I <br /> i <br /> i <br /> I <br /> I <br /> i <br />