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ASSOCIATED LABORATOAMS <br /> 806 North Batavia_Orange, California 92868,1225- 7141771-6900 FAX 7141538-1209 <br /> Cooler Receipt Form <br /> Client. rt FKA Project• <br /> Date Cooler Received: Date Cooler Opened: 1 ! — 12— <br /> Was <br /> ZWas cooler scanned for presence of radioactivity? <br /> If yes was radioactivity results above 25 cpm ? Ye <br /> Ye� <br /> Was a shipper's packing slip attached to the cooler? (:Ye?No <br /> If the cooler had custody seals),were thy signed and intact? oma <br /> Was the cooler packed with: Ice Packs Bubble wrap - <br /> Styrofoam Paper--e�=�one Other <br /> ID <br /> Cooler Temperature: 3 b C�_ <br /> . *cooler needs to be received @ 4°C with an acceptable range of 20-6 °C <br /> If samples were hand delivered do they meet the temp critena, which should be @ 4°C with <br /> an acceptable range of 2°- 6 'C ? <br /> eS O <br /> If no explain <br /> Were all samples sealed in plastic bags ? Ye o <br /> Did all samples arrive intact?If no, indicate below <br /> KTe No <br /> Were all samples labeled correctly? (ID's Dates,Tunes) If no, indseate below tYes/-No <br /> -- - -- --- <br /> Can the tests required be ran with the provided containers, If no indicate below. Ye o <br /> Was sufficient sample volume sent for all containers ? <br /> es o <br /> Were any VOA vials received with head space? <br /> Yes/�/1Va <br /> Was the correct preservatives used ? <br /> If no, see the pH log for a list of samples containers regarding pH o/Na <br /> iAny other unportant information- <br /> Receiving eceivuig DepartFnent. Date <br />