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I <br /> A SOCUTED LABORATO Es <br /> North Batavia Orange, California 928681225 W 7141771-6900 FAX 7141538-1209 � <br /> Cooler Receipt Form <br /> Client- �� Project: TbG f 7 2-- <br /> Date Cooler Received: . .- - Y Date Cooler Opened: —Z <br />' Was cooler scanned for presence of radioactivity ? Yes o <br /> If Yes was radioactivity results above 25 cpm 7 Ye <br /> Was a shipper's packing slip attached to the.cooler? (Ze'pNo <br /> If the cooler had custody seal(s),were thy signed and intact? Yes/N /Na <br /> Was the cooler packed with: Ice X. Ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> Cooler Temperature: 4-0,0(2, <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 bea�4°C with <br /> an acceptable range of 2'- 6 *C ? ye o <br />' If no explain: <br /> Were all samples sealed in plastic bags ? (i�e---a <br />' Did all samples amve intact?If no, indicate below. �o <br /> Were all samples labeled correctly? (ID's Dates, Tunes)If no, indicate below. RJo <br />' Can the tests required be ran with the provided containers, If no indicate below. es/ To <br />' Was sufficient sample volume sent for all containers ? es o <br /> Were any VOA vials received with head space Yesa <br /> Was the correct preservatives used 7 es o/Na <br /> If no, see the pH log for a list of samples containers regarding pH <br />' Any other important uiformation: <br /> f ? <br />' Receiving Department _ - �'Yi/ Date• - _— <br />