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ASS0CL4TFD LABORATO=S <br /> 806 North Batavia - Orange, California 92868-1225- 7141771-6900 FAX 714/538-1209 <br /> Cooler receipt Form <br /> Client _7LI 01 [ <br /> Prod ect <br /> Date Cooler Received. l b Date Cooler Opened <br /> Was cooler scanned for presence of radioactivity 9 o <br /> If yes was radioactivity results above 25 cpm ? Ye o <br /> Was a slipper's packing slip attached to the cooler ? Yes1To) <br /> If the cooler had custody seal(s), were thy signed and intact? Yes/No a <br /> Was the cooler packed with: Ice k Ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> Cooler Temperature �'d 4 <br /> • `cooler needs to be received @ 4°C with an acceptable range of 2°- 6 °C <br /> If samples were hand delivered do they meet the temp criteria, which should be @ 4°C with <br /> an acceptable range of 2°- 6 'C 9 Yes/No <br /> If no explain <br /> Were all samples sealed in plastic bags 9 Yes o <br /> Did all samples arrive intact?If no, indicate belowes o <br /> Were all samples labeled correctly ? (ID's Dates, Tunes) If no, indicate below Y o <br /> Can the tests required be ran with the provided containers, If no indicate below es o <br /> Was sufficient sample volume sent for all containers Yes o <br /> Were any VOA vials received with head space ? Yes o <br /> Was the correct preservatives used 9 Yes /Na <br /> If no, see the pH log for a list of samples containers regarding pH <br /> Any other important information <br /> Receiving Department Date —7Z UZ-S <br />