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' A ASSQCMTED LAEoRAToPjEs <br /> �Q6 North Batavia- Orange, California 92868-1225- 714/771-6900 FAX 714/x381209 <br /> 1 Wooler Receipt Form <br />' Client _4_4� -_ <br /> Project Ca C. 7 <br /> Date Cooler Received: .�_ Date Cooler Opened. <br /> Was cooler scanned <br /> for presence of radioactivity ? Ye <br /> If yes was radioactivity results above 25 cpm ? Ye o <br /> Was <br /> a shipper's packing slip attached to the cooler ? e <br />' If the cooler had custody seal(s), were thy signed and intact? e o/Na <br /> i Was the cooler packed with Ice Ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> Cooler Temperature-_ -L _�,O <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 />�3 an acceptable range of 2°- 6 °C ? <br />' If no explain. <br /> 0 <br /> Were all samples sealed in plastic bags ? QYe No <br />' Did all samples arrive intact?If no, indicate <br /> below. (Y��No - <br />' Were all samples Iabeled 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. GY -t/No <br />' Was sufficient sam <br /> ple volume sent for all containers ? &No <br /> Were any VOA vials received witti head space ? Ye a <br />' Was the correct preservatives used ? Ye o/Na <br /> If no,see the pH log for a bA of samples containers regarding pH <br />' Any other important information- <br /> M <br />' Receiving Department. Date <br />