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LA <br /> ASSOMTED LABORATOJUES <br /> 806 North Batavia- Orange, California 92868-1225- 714/77_-6900 FAX 714/538-1209 <br /> Cooler Receipt Form <br /> ClientkLe ' Project <br /> Date Cooler Received. , <br /> Date Cooler Opened. <br /> Was cooler scanned for presence of radioactrvi <br /> t3' Yes <br /> If yes was radioactivity results above 25 cpm ? Yes1No <br /> Was a shipper's packing slip attached to the cooler <br /> Yes <br /> If the cooler had custody seal(s),were thy seed and intact ? Yes/No a <br /> Was the cooler packed with- Ice F'acks Bubble wrap <br /> Styrofoam _'aper None Other <br /> Cooler Temperature- '/, J a * <br /> °cooler needs to be received @ J-°C wrta an acceptable range of 2°- 6 °C <br /> If samples were hand delivered do they meet the temp entena, which should be @ 4'C with <br /> an acceptable range of 2°- 6 °C ? Yes/No <br /> If no explain <br /> Were all samples sealed in plastic bags ? 12/No <br /> Did all samples arrive intact ?If no, indicate below <br /> OYNo <br /> Were all samples labeled correctly ? (ID's Dates, `fames) If no, inaicate below -As,/No <br /> Can tha tests required be ran with the provided containers. If no indicate below ING <br /> I Was sufficient (/ <br /> int sample volume sent for all containers <br />' Were, any VOA vials received with head space ? YesCN <br /> Was the correct preservatives used ? Yes/N <br /> If no, see the pH log for a list of samples containers regarding pH <br /> Any other important information <br /> Rtcvt Frog DeparLnSeAAt <br /> Date �_ V <br />