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s I <br /> ASSoMM LABo <br /> RArDRmS <br /> 1 eye BataWa_orange, CdY fornta 928681225- 7141771-6900 iWpAX 714/538-.I209 <br /> Cooler Receipt Form <br /> Client; <br /> Project: W 9 <br /> Date Cooler Received: — 1_1, Date Cooler Opened. 8- 13 <br /> Was cooler scanned for presence`of radioactivity 7 <br /> ,If yes was radioactivity rem9ts above 25 cpm ? Y o <br /> Y o <br /> 'Was a shipper's packing slip attached to the cooler? ( <br /> 0 <br /> If the cooler had custody seal(s),were thy signed and intact? Y o/Na <br /> Was the cooler packed with:IceIce Packs <br /> —� Bubble wrap—� <br /> styrofoam- ...Paper None. Other. <br /> Cooler Temperature- -a-, &'C' * �� <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 Q 4('C with <br /> r an acceptable range of 2 6 OC? <br /> If no explain.: <br /> Were all samples sealed in plastic bags ? <br /> I �No <br /> Did all samples arrive intact?If no,indicate below. �NO <br /> Were all samples labeled correctly 7(ID's Dates, Tunes)Ifno, indicate below. �o <br />' Can the tests required be ran with the provided containers, If no indicate.below, (Ye�N-o <br />' was sufficient sample volume sent for all containers ? (K"� o <br /> Were MY VOA viafs received with head' space? Yes/1&-Na <br /> Was the correct preservatives used 7 <br /> If no, see the pH log for a list of samples containers re Ye`� No/Na <br />' girding PH <br /> Any other important inform,at2on: <br /> 10 <br />' Receiving Department: Date: 8 — !3 <br />