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JAN-22-20113 14.32 CAL5CIENCE 714 894 7501 P.17120 <br /> ..s�.r big. WORK ORDER#: 03-® E1 - 9 ® 0 K � <br /> Cooler, of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: KI - DATE:_ 0 l f 16LO-3 <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCIE=COURIER: - LABORATORY(Other than Cakcleow Coud ed: <br /> Chilled.Cooter with temperahn blank PmYWW, °C Tompwatum blank <br /> ChOW.cmier without twnperahwe blank. °G IR d ion,omuW. <br /> Chilled and placed in Cooler with wet loe. Ambient temperature. <br /> Ambient and placed In cooler with wet ios. <br /> AmWent tonpersture. <br /> °C TompenMrs ink. InRW- <br /> F,9g=MpTk4sYD. <br /> Y SEAL INTACT: <br /> Coder:—y' No(Nat Intact). Not applicable(WA) <br /> Inm: <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chen-Of-C wRA samples <br /> ustady doownenae)rooelved .... . ... .,..... . .... ....... <br /> =Sample container Isbel(s)consistsrttwith ais6ody papm................ _- <br /> -- Sample and good cond[tlart_. _. . .. ._ .....,, _� <br /> Correct containers for analyses requested <br /> Proper pneservation noted on sample label(s)__ - - - - - - - - - - - --- <br /> VOA vlai(s)free of Nwdepsce .., ....... ........ ...... .. . . _....., <br /> Tedlar bag(s)frw of conderwation <br /> Enittal: �� <br /> -COMMENTS: <br />