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Page 46 of 59 ' <br /> - WORK ORDER #: 08 - ® _ o © a a <br /> Cooler Z of 3 <br /> SAMPLE RECEIPT FORM <br /> CLIENT:_ 5(01'V�e h f c� DATE: <br /> TEMPERATURE — SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than Calscience Courier): <br /> Chilled, cooler with temperature blank provided. _ 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......................... <br /> ... ... . ... ... . <br /> Sampler's name indicated on COC....................................... <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)..................................... 1� ' <br /> VOA vial(s)free of headspace. ....................................................... ✓... ... . <br /> Tedlar bag(s)free of condensation.......................... <br /> Initial: 1 <br /> COMMENTS: <br /> - 1 <br />