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r�tro+�r <br /> .Rnnarr�el E <br /> Fq N [9abrnr tarrta l enc. WORK ORDER #: 02- ❑ 0❑ - <br /> Cooler „ _ of <br /> SAMPLE RECEIPT FORM <br /> CLIENT: K FF DATE: <br /> TEMPERATURE — SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY (Other than Calscience Courier): <br /> Chilled, cooler with temperature bunk provided 2 °C Temperature blank - <br /> Chilled, cooler without temperature blank °C IR thermometer <br /> Chilled and placed in cooler with wet ice Ambient temperature <br /> Ambient and placed in cooler with wet ice <br /> Ambient temperature <br /> °C Temperature blank Initial N <br /> CUSTODY SEAL INTACT: / <br /> Sample(s) Cooler ✓ No (Not Intact) Not Applicable (NIA) <br /> Initial <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chain-Of-Custody document(s) received with samples <br /> Sample container labels) consistent with custody papers <br /> —Sample container(s) intact and good condition _ - — -- - <br /> _Correct containers for analyses requested - <br /> Proper preservation noted ori sample label(s) <br /> VOA vial(s) free of headspace ✓�` <br /> Tedlar bag(s)free of condensation ✓ <br /> Initial <br /> COMMENTS: <br />