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F <br /> v <br /> r, <br />- L� . A ,} _.�..... _.-...- �.._.,... t-""---- ,,.- ....... w+w. ..- -...... ...,..»..».ate H.-�w..».-.--. .•r ....-,.,,._.-...a.-......»-« ..._..._..r...- ..».._...-..»-..,..`. , M..... <br /> C <br /> ASSOCIATED LABORATMES <br /> 806 North Batavia-Orange, California 928681225- 714/771-6900 iAX 7141538-1209 <br /> Cooler Receipt'Forin <br /> Client: d .a, - -- Project: TD C. 17 2— <br /> Daft <br /> Date Cooler Received:. Dite Cooler Opened: <br /> Was cooler scanned for presence.of radioactivity? Yews/ <br /> if yes was radioactivity results above 25 conn? Y <br /> Was a shipper's packing slip attached to the cooler? o <br /> If the cooler had custody seal(s),were thy'signed and intact? " ' V <br /> Yes/Nout Ca " <br /> Was the cooler packed with:Ice ✓ lee Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> T _C <br /> Cooler Temperature: c_ <br /> *cooler needs to be received(cry 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 /> - an acceptable range of 2'-6°C <br /> 4 <br /> - ----If no explain:_ ------ - -----_- --- ,-- -- -- - ----- -- - - - --- �_ _ - _ - - <br /> Were all samples sealed in plastic bags 7 o <br /> Did all samples arrive intact?If no,indicate below.- (9No <br /> Were all samples labeled correctly?(ID's Dates,Times)If no,indicate below. 6Y NO <br /> Can,the tests=Vired be ran with the provided containers,If no indicate below. CCSINO' <br /> Was sufficient sample volume sent for all contkiners? (9so <br /> Were any VOA vials received with head space? Yeslo a <br /> Was the co=d preservatives used? SNoINa <br /> If no, see the pH log for a list of samples containers regarding pH <br /> Any other important information: - - - - - r - <br /> Recceiving Department (Yy' Date: to <br />