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Page 8 of 8 <br /> #�rr+alae°�e rr�C6r <br /> �vira�rrrsfanta� WORK ORDER #• O - El E - F] <br /> • <br /> Cooler 1 of _1 <br /> SAMPLE RECEIPT FORM <br /> CLIENT: DATE: <br /> TEMPERATURE — SAMPLES RECEIVED BY <br /> CALSCIENCE COURIER LABORATORY (Other than Calscience Courier) <br /> Chilled, cooler with temperature blank provided rA °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 U)'% <br /> CUSTODY SEAL INTACT: <br /> Sample(s) Cooler No (Not Intact) Not Applicable(NIA) <br /> Initial �� • <br /> SAMPLE CONDITION. <br /> Yes No NIA <br /> Chain-Of-Custody document(s)received with samples <br /> Sample container label(s)consistent with custody papers <br /> Sample container(s)intact and good condition <br /> Correct containers for analyses requested / <br /> Proper preservation noted on sample label(s) <br /> VOA vial(s)free of headspace <br /> Tedlar bag(s)free of condensation <br /> Initial <br /> COMMENTS: <br />