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Z=r1Wt'0d'&jV' <br /> ORFC ORDER : -�© - n®®® <br /> Inc. <br /> Cooler I _ of <br /> SAMPLE RECEIPT FOR <br /> CLIENT: L W DATE: /1 17 <br /> TEMPERATURE—SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than Calscience Courier): <br /> Chilled, cooler with temperature blank provided. ( , OC 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 /> OC Temperature blank. Initial: <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler.—I�Z No(Not Intact) : Not Applicable(N/A): <br /> Initial:�tni <br /> SAMPLE CONDITION: <br /> Yes No N/A <br /> Chain-Of-Custody document(s)received with samples.................. <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).................................. <br /> VOA vial(s)free of headspace. ......................................... <br /> Tedlar bag(s)free of condensation.................... <br /> ....... <br /> Initial: <br /> COMMENTS: <br />