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%V=0M*"ft1 <br /> Efporwt-cdefi, <br /> WORK ORDER #: -as - nOMME <br /> 1n <br /> Cooler _� of , <br /> SAMPLERECEIPT FOR <br /> CLIENT: L W- DATE: f 0 <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY (Other than Caiscience Courier): <br /> Chilled,cooler with temperature blank provided. °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: <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler._ No(Not Intact) : Not Applicable(N/A): <br /> Initial: <br /> SAMPLE CONDITION: <br /> Yes No N/A <br /> Chain-Of-Custody document(s)received with samples......................... (z .,...,• ,,. <br /> Sample container label(s)consistent with custody papers..................... ... .... ..,,., <br /> Sample container(s)intact and good condition................................... _ _.., .,•, <br /> Correct containers for analyses requested......................................... .....,, <br /> Proper preservation noted on sample label(s)..................................... ....... ........ LZ <br /> _ <br /> VOA vial(s)free of headspace. ....................................................... ... .... <br /> Tedlar bag(s)free of condensation....................................I.............. // <br /> Initial: <br /> COMMENTS: <br />