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WORK ORDER 04 <br /> Cooler of <br /> SAMPLEIPT FOR <br /> CLIENT: { DATE: d <br /> TEMPERATURE-SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY(Other than Calsctence Courter): <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: �v <br /> CUSTODY SEAL INTACT: <br /> Sample(s): Cooler. tz No(Not Intact): Not Applicable(NIA): <br /> Initial: <br /> SAMPLE CONDITION: <br /> Yes No NIA <br /> Chain-Of-Custody document(s)received with samples......................... j/ ....... <br /> Sample container label(s)consistent with custody papers....................._—V ... ....... .... ....... <br /> Sample container(s)intact and good condition.................................. _b' ,.,, ... <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 /> . r <br /> Initial: <br /> COMMENTS: <br />