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-UL-11-20M 15 es <br /> P 06/@7 <br /> Ar ku*ft•ter *NL WORK ORDER#: 03 JOE - BHS M <br /> Air-0130 <br /> Cooler I _ Of <br /> SAMPLE RECEIPT FORM <br /> CLIENT; kI"F' <br /> DATE:- <br /> TEMPERATURE--SAMPLES RECEIVED BY: <br /> CALSCilENCE COURIER: LABORATORY(Other than CaIscience Courier): <br /> Chilled, cooler with bempenttlra blank provided _ °C Temperature blank <br /> Chilled, Cooler wtthout temperature blank OC IR thermometer <br /> Chilled and placed In cooler with wet ice Ambient temperature <br /> Ambient and ptace4 in cooler with wet IG <br /> Arnbient temperature <br /> C Temperature blank. <br /> Initial ! <br /> CUSTODY SEAL INTACT: <br /> samp;e(s) ------ Cooler- No(Not Intact) <br /> Not Applicable(NIA) <br /> Initial ` <br /> SAMPLE CONDITION: <br /> Chain-OhCustody documents)received with samples Yes No NIA <br /> Sample container labels)oonsistent with cu <br /> study pgPare <br /> Sample container(s)Intact and ggod Canditn <br /> COMW containers for analyses • ,. '.. <br /> requested <br /> Proper preservation noted on sample label(s) <br /> VOA vigl(s)free of headspaoe <br /> Tedlar bag(s)free of condensation_ '—rL <br /> Initial <br /> COMMENTS: <br />