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T O <br /> ASSOCL-1 TED LAB <br /> RA TORIES <br /> 806 North Batavia - Orange, California 92868-122. - 7141771-5900 FAX 7.141538-1209 <br /> Cooler Receipt Form <br /> Client Project Z- <br /> Date Cooler Received. Date Cooler Opened_ { <br /> Was cooler scanned for presence of radioactivity ? Yes o <br /> If yes was radioactivity results above 25 cpm ? Yes o <br /> Was a shipper's packing slip attached to the cooler ? eslNo <br /> If the cooler had custody seal(s),were thy'signed and intact ? "es�No/Na <br /> Was the cooler packed with Ice�yo� lee Packs Bubble wrap <br /> + styrofoam Paper None Other <br /> Cooler Temperature G <br /> • *cooler needs to be, received @ A°C with an acceptable rangy of 2°- 6 °C <br /> If samples were hand delivered do they meet the temp criteria, wbich should be 4°C with <br /> an acceptable range of 2 6 °C Yes <br /> If no explain. <br /> Were all samples sealed in plastic balls ? Yes/No <br /> Did all samples arrive intact? If no, indicate below (Yes/No <br /> Were all samples labeled correctly ? (ID's Dates, Times) If no, indicate below (71�s/No <br /> Can the tests required be ran with the provided containers, If no indicate below CICSINO <br /> Was sufficient sample volume sent for all containers ? Ye /NO <br /> Were any VOA vials received with head space ? Ye /No a <br /> Was the correct preservatives used ? OYeINo/Na <br /> If no, see the pH log for a list of samples containers regarding pH <br /> Any other important information <br /> Receiving Department 6 Date <br />