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I <br /> ASSOM TED LAB ORA TORIES <br /> 806 North Batavia - Orange, California 92868-1225- 7141777-6900 FAX 7141538-1209 <br /> Cooler Receipt Form <br /> Client y Prod ect. <br /> Date Cooler Received: -S °3 Date Cooler Opened S 3 <br /> Was cooler scanned for presence of radioactivity ` s <br /> If yes was radioactivity results above 25 cpm ? Ye o <br /> Was a shipper's packing slip attached to the cooler YesCD <br /> If the cooler had custody seal(s),were thy signed and intact*7 Yes/N(S) <br /> es/N /Na <br /> Was the cooler packed with- Ice )< Ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> . Cooler Temperature 21'0 <br /> *cooler needs to be received @ 4°C with an acceptable range of 2°- 6 °C <br /> If samples were band dehvered do they meet the temp criteria, Much 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 ? Yes o <br /> Did all samples arrive intact?If no, indicate below o <br /> Were all samples labeled correctly ? (ID's Dates, Tunes) If no, indicate below. es o <br /> Can the tests required be ran.with the provided contaimers, If no inchcate below e o <br /> Was sufficient sample volume sent for all containers ? es o <br /> Were any VOA vials received with head space ? YesoII a <br /> Was the correct preservatives used ? �9o/Na <br /> If no, see the pH log for a list of samples containers regarding pH <br /> Amy other important information <br />