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JUN-69--MM 17:12 � <br /> P.06 <br /> WORK ORDER#: Q <br /> Cooker f o <br /> SAMPLE RECEIPT FORM <br /> CLIENT:, +!'FF DATE: ir4ld 3 <br /> FrnMPER—ATURE—SAMPLES RECEIVED BY: <br /> ALSCIENCE COURIER; LABORATORY(Other than Calecience Courier): <br /> Chilled.cooler with temperature blank provided. t 'C Temperature blank. <br /> Chilled,cooler without temperature blank. °C IFS thermometer. <br /> Chilled and placed in cooler with wet ice. Ambient temperature. <br /> Ambient and placed in cooler with we[Ice. <br /> Ambient temperature. <br /> °C Temperature blank. Initial: <br /> CUSTODY SEAL INTACT: <br /> Semple($): Cooler:' No(Not Intact): Not Applicable(NIA): <br /> Initial: <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chain-Of-Custody documents)recehred with sampies......................... .... . ... <br /> Sample container label(9)consistent with custody papers..................... ....... ....... <br /> Sample container(s)Intact and good condition................................... _ ...,-.- ....... <br /> Correct oentainem for analyses requested........................................ L/'. .... -- <br /> Proper preservation noted on sample label(a).................................... ... ...... L�� <br /> VOAvial(s)free of headspace. ....................................................... ...., ... <br /> Tedler beg(s)free of condensation................................................... . .... . ....�/ <br /> ' Initial: <br /> COMMENTS: <br />