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> � WORK ORDERst.. 9R.�j M <br /> 9 ED M <br /> Ei <br /> Cooler_._. of— / <br /> SAMPLE RECEIPT FORM <br /> CLIENT: k1_FF DATE; Oq I �� <br /> T <br /> EMPERATURE—SAMPLE RECEIVED DBY: <br /> COURIER: LABORATORY(Other then Calsclence Courfer): <br /> � Chilled,cooler with temperature tofank provided _a Temperature bkmk <br /> Chilled,cooler without temperaWre blank '°C IR themwmeter_ <br /> Chilled and p In cooler with wet ce Ambient ternperature. <br /> _Ambient and placed In cooler with wet ice. <br /> Ambient Wnpenftro.. <br /> °C Temperate*blank. Invaf: �•✓ <br /> Ci13TCDV SEAL INTACT: <br /> Samples) Cooter No(Not Intacf). i lkable N/A), <br /> tidal: <br /> AhIIPLE CONDMON: <br /> Yes No NIA <br /> Chain-V-Custody aocument(e)recelvea watt,samplw <br /> Sample container labet(s) Conspjhmt wfih custody _ --- .. <br /> .... <br /> e <br /> �Mpl <br /> e contalnerts)intact and —�---�- <br /> gooa oondltbn . ........ . ,.. ... ��.... <br /> nfecteontolne'rs for analym MgUesteaPimpe ••�—"— -•- <br /> r p>aaervatiat noted onnrple ........... <br /> VCA,Wags)Ree of hendspaw. .....: .. ............ ..... . . ... ,. ....+ <br /> Tedlar bag(s)fte of cardMian , .......,. „� ... ...... <br /> . <br /> COMMENTS: <br /> TOTAL P.07 <br />