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' Page 45 of 59 <br /> WORK ORDER #: 08 <br /> h To. Cooler I_ of �1 <br /> 1 SAMPLE RECEIPT FORM <br /> ' CLIENT: Ici( we I- e C'� DATE: �Zo ( ©� <br /> TEMPERATURE — SAMPLES RECEIVED BY: <br /> ' CALSCIENCE COURIER: LABORATORY (Other than Calscience Courier): <br /> Chilled, cooler with temperature blank provided. — 3 3 °C Temperature blank. <br /> Chilled, cooler without temperature blank. __ _ °C IR Thermometer. <br /> Chilled and placed in cooler with wet ice. Ambient temperature(For Air & Filter Only). <br /> Ambient and placed in cooler with wet ice. <br /> Ambient temperature(For Air&Filter Only). <br /> 'C Temperature blank. Initial: <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler: No(Not Intact) : Not Present: <br /> Initial: <br /> ' SAMPLE CONDITION: <br /> Yes No N/A <br /> ' Chain-Of-Custody document(s)received with samples......................... L,-- ... ... . <br /> Sampler's name indicated on COC................................................. Y ... ... . <br /> ' Sample container label(s)consistent with custody papers..................... ✓ : .. <br /> Sample container(s) intact and good condition................................... .. ... .... <br /> Correct containers and volume for analyses requested....................... ✓ ... .... ... .... <br /> Proper preservation noted on sample label(s)..................................... ... .... ... ... . <br /> VOA vial(s)free of headspace. ....................................................... ... ... . <br /> Tedlar bag(s)free of condensation........................... ... ... . <br /> ' Initial: <br /> ' COMMENTS: <br />