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ASSOCIATED LABORATORIES <br /> 8 North Batavia- Orange, California 92868-1225- 7141771-6900 FAX 71415381209 <br /> Cooler Receipt Form <br /> Client. kl4q, _ Q �r Project <br /> Date Cooler Received. Date Cooler Opened <br /> Was cooler scanned for presence of radioactivity ? YesTo <br /> If yes was radioactivity results above 25 cpm ? Yes o <br /> Was a shipper's packing slip attached to the cooler? Yes&O <br /> If the cooler had custody seal(s),were thy signed and intact? Yes/No/8 <br /> Was the cooler packed with Ice ice Packs Bubble wrap <br /> Styrofoam Paper None Other <br /> Cooler Temperature- F °� <br /> • *cooler needs to be received @ 4°C with an acceptable range of 2°- 6 °C <br /> If samples were hand delivered do they meet the temp criteria, which should be @ 4°C with <br /> an acceptable range of 2°- 6 °C Yes/No <br /> If no explain- <br /> Were all samples sealed in plastic bags 9 e o <br /> Did all samples arrive intact?If no, indicate below e o <br /> Were all samples labeled correctly '9 (ID's Dates, Times) If no, indicate below Ye /No <br /> Can the tests required be ran with the provided containers, If no indicate below. C1110 <br /> Was sufficient sample volume sent for all containers ? o <br /> Were any VOA vials received with head space ? Yesl /Na <br /> Was the correct preservatives used ? 1e TNo/Na <br /> If no, see the pH log for a list of samples containers regarding pH <br /> • Any other important information. <br /> Receiving Department Date ( r `� <br />