Laserfiche WebLink
RL-26--2002 11.54 CALSC1ENCE 714 894 7501 P.07/07 <br /> �� mom► � <br /> ebor�stenti" fr�c�. WORK ORDER #. �Z ® © ® © � ❑ <br /> Vo <br /> Cooler Of <br /> SAMPLE RECEIPT FORM! <br /> CLIENT-,L L ~� + <br /> 7CALSCIEINCE <br /> ATURE —SAMPLES RECEIVED BY: <br /> COURIER: LABORATORY(Other than Caledence Courier): <br /> hilled.cooler with temperature blank provided. °G 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 tee <br /> Ambient temperature <br /> ' °C Temperature blank Initial �Y <br /> CU SUL INTACT: <br /> Cooler=,� No(Not Intact). Not Applicable(NIA). <br /> Initial: Q <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> _S ample container label(3)consistent with Cuat aro....... ... . ...... ..... ....... — <br /> Sample container(s)intact and good condition.... J.. .. ....... <br /> - <br /> Proper preservation noted on sample label(s).. .. . .. _.. .. .....::_� <br /> VOA vial(s)free of headspaw ....... <br /> Tedlar bag(a)free of condensation .... <br /> COMMENTS: <br /> TOTAL P.@7 <br />