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ASSOM TED LABORATORIES <br /> q06 Nortx=Bata-pia- Orange, California 92868-1225 - 7141771-6901 FAX 7141538-1209 <br /> Cooler Receint Form <br /> Client <br /> � r <br /> Was cooler scanned for presenca of radzoactnaty '? Yes/l <br /> if yes was radioa.cmq y results above 21 clam <br /> e�fl � <br /> Was a shipper's par-kang slip attached to the cooler ? Yes, <br /> If the cooler had ct:stcdy seal(s), vvera 1hy signed and intact ` 9e o/Na <br /> Was the choler packed;;arth- ice V/ Ice Packs �e�b�la vvra�a <br /> tyrcfcam Paner _ i� one Other <br /> a <br /> Cooler Temperamre _ � -7 v _ <br /> • cooler needs to be -�C;e-rved A d°C vire an ac-= a.ale range of'-°- 6 , C <br /> 110 samples vwtr° gaud d.elivered do they mt--t tac TC MM cr��riG, vlhicn aho'wd t faa <br /> an acc eptaible ra ge Gz 2o- 6 0C <br /> .� r' 0 <br /> If no e�� <br /> Were all samples sealed in plasnc bags ? s/I�3o <br /> Did all samples ari-ve mtact ?If no, mdreare below Yesr'Nc <br /> Were all samples labeled correctly ? (ID's Dates, Tunes) If no, ml,cate below <br /> GeSiNo <br /> Can the tests req=ed be ran with the provided containers, if no indicate below CeSINO <br /> Was sufflckent sample volume sent for all containers ? Ye INo <br /> Were any VOA vials received with head space 9 Yes�fo Na <br /> Was the correct preservatives used ? Y"es/N- a <br /> if no, Seethe pH loo Tor a list of samples containers regarding pH <br /> . Any ether impormt inf€armaton <br /> Receiving Depannent � Date <br />